Fast Five Quiz: Urinary Tract Infection

Both nitrofurantoin and trimethoprim-sulfamethoxazole are acceptable empirical treatment options for men in long-term care facilities. Although nitrofurantoin is often underused in older patients because it is contraindicated in persons with renal insufficiency, data suggest that it is effective in treating UTIs in older adults with a creatinine clearance > 40 mL/min.

Acute prostatitis typically presents with spiking fever, chills, malaise, myalgia, dysuria, pelvic or perineal pain, and cloudy urine. Obstructive symptoms can result from swelling of the acutely inflamed prostate; such symptoms range from dribbling and hesitancy to anuria. Less commonly, patients present with a vague, flulike illness.

Careful examination of the prostate is not contraindicated in acute bacterial prostatitis, but prostatic massage is contraindicated. Upon examination, the prostate is warm, swollen, soft ("boggy"), and extremely tender. The patient may have a fever and appear acutely uncomfortable; hypotension may be noted.

Dysuria, frequency, urgency, and suprapubic pain usually are present in men with cystitis. Fever and flank pain may be present but are not usually noted. Symptoms cannot reproducibly differentiate cystitis (lower UTI) from pyelonephritis (upper UTI). As is the case with women, a positive nitrite test is poorly sensitive but highly specific for UTI in men, and false-positive results are uncommon.