Approach to managing acute cystitis in adult males
The prevalence of cystitis in males1 increases with age and is often related to abnormalities of the urinary tractSchaeffer, 2016. Consider acute bacterial prostatitis in males with fever (38°C or higher), obstructive urinary symptoms or prostate tenderness on gentle digital rectal examination. Consider chronic bacterial prostatitis in males with recurrent urinary tract infection (UTI).
Treat adult males with acute cystitis with an antibiotic and offer analgesia.
Many clinicians advise increased fluid intake during an episode of acute cystitis to help manage the symptoms, but evidence to support this advice is lacking.
The efficacy of urinary alkalinising agents for the symptomatic treatment of acute cystitis has not been established in trials but some patients find them useful for symptom reliefO'Kane, 2016. Urinary alkalinising agents significantly reduce the antimicrobial effect of nitrofurantoin, and they should not be used with quinolones (eg ciprofloxacin) because there is an increased risk of crystalluriaCunha, 2017O'Kane, 2016.
Cranberry products, ascorbic acid and methenamine hippurate are not effective for the treatment of acute cystitisNational Institute for Health and Care Excellence (NICE), October 2018.