Guidelines for the management of male urinary tract infections in primary care: a lack of international consensus—a systematic review of the literature.

This article systematically reviews international clinical practice guidelines for the diagnosis and management of adult male urinary tract infections (mUTIs) in primary care, assessing their methodological quality and evidence-based strength of recommendation (SoR). It identifies significant heterogeneity in mUTI definitions, classifications, and treatment approaches across 29 updated guidelines from 24 countries, with fluoroquinolones (FQs) recommended as the gold standard for febrile mUTIs and prostatitis, while some Northern European guidelines advocate shorter, FQ-sparing regimens for afebrile cases. The overall quality of guidelines varies, with many relying on expert opinion and low levels of evidence, reflecting a lack of international consensus and limited primary care-specific research. The review highlights the need for improved guideline development, consideration of antimicrobial resistance patterns, and further primary care-focused studies to optimize antibiotic stewardship in managing male UTIs.