Mount Carmel Health Partners Clinical Guidelines Urinary Tract Infection | Page 2

UTI Treatment Algorithm for Adult Males
Evaluation
Adult male presents with
dysuria, suspected UTI
UA is negative for leucocytes or
nitrites but positive for blood
Treatment
Obtain history and complete examination. Consider urethritis,
prostatitis, and epididymo-orchitis.
• Urinalysis (UA)
• Catheterized patients: replace catheter and collect urine from
clean catheter
• Consider urethral swab for gonorrhea or chlamydia or nucleic
acid amplification test (NAAT) via urine sample in sexually active
males
If UA is positive for bacteriuria,
leucocytes, or nitrites, perform urine
culture and sensitivity (C/S)
Send sample for microscopy
and urgent urological referral if
significant hematuria
Start first-line antibiotics for
10 days; review patient with
urine cultures at 48 hours No Is the patient
systemically ill:
fever, flank pain, or
evidence of
epididymo-orchitis?
Was the
culture
positive? Yes Adjust antibiotics
according
to sensitivities
Consider urethral stricture or
alternative diagnosis
Yes
Consider Emergency
Department evaluation or
Direct Hospital Admission;
Consider and treat prostatitis
or SIRS (systemic
inflammatory response
syndrome) with UTI;
consider urology consult
Yes
No
Are the
patient’s
symptoms
improving?
Consider alternative diagnosis and
referral to specialist if persistent
hematuria or sterile pyuria
Yes
No
Finish antibiotics;
repeat urine culture
after one week
Treatment Complete;
Consider renal
ultrasound and referral to a
urologist if this is the second UTI
No abnormalities
detected
Repeat UA with C/S
and start second
line antibiotics
Is the patient
systemically ill:
fever, flank pain, or evidence of
epididymo-orchitis?
No
No
Was the
culture
positive?
Consider ultrasound and
referral to a urologist
Yes
Treat with antibiotics,
ultrasound, and referral to a
urologist
UTI - 2
Because urinary tract infections are uncommon in
males, sexually transmitted diseases (STDs) and/or
prostatitis therefore must be considered.