From the Guidelines
Recurrent urinary tract infections (UTIs) in men should be treated with antibiotics for 7-14 days, with the specific duration depending on the underlying cause and the patient's clinical response, as recommended by the European Association of Urology guidelines 1. The treatment of recurrent UTIs in men requires a thorough evaluation to identify underlying causes, which can include obstruction at any site in the urinary tract, recent history of instrumentation, or underlying medical conditions such as diabetes mellitus or immunosuppression 1.
- Initial treatment typically involves antibiotics such as trimethoprim-sulfamethoxazole (Bactrim DS) 1 tablet twice daily, ciprofloxacin 500mg twice daily, or nitrofurantoin 100mg twice daily.
- The duration of treatment can range from 7 to 14 days, with some studies suggesting that shorter courses of treatment may be effective in certain cases 1.
- A study published in 2023 found that short-duration therapy (5-7 days) resulted in similar clinical success as long-duration therapy (10-14 days) in patients with complicated UTI, including men 1.
- However, another study found that 7-day ciprofloxacin therapy was inferior to 14-day ciprofloxacin therapy for short-duration clinical cure in men with complicated UTI 1.
- Preventive measures, such as increased fluid intake, complete bladder emptying, and maintaining good hygiene, can also help prevent future infections.
- Some men may benefit from prophylactic antibiotics, such as trimethoprim-sulfamethoxazole 1 tablet three times weekly for 6 months.
- Cranberry supplements may also help prevent bacterial adhesion to the urinary tract. The European Association of Urology guidelines recommend that the treatment of recurrent UTIs in men should be tailored to the individual patient's needs, taking into account the underlying cause of the infection, the patient's clinical response, and any underlying medical conditions 1.
- The guidelines also recommend that a urine culture and susceptibility testing should be performed to guide antibiotic therapy.
- Appropriate management of the urological abnormality or underlying complicating factor is mandatory to prevent future infections.
- The microbial spectrum of recurrent UTIs in men can be greater than that of uncomplicated UTIs, and antimicrobial resistance is more likely 1.
- Therefore, it is essential to choose an antibiotic that is effective against the specific uropathogen isolated and to monitor the patient's response to treatment closely.
From the Research
Recurrent UTI in Men
- Recurrent urinary tract infections (UTIs) are a common problem in adults, and can be burdensome and detrimental to a patient's quality of life 2.
- The incidence of UTIs in men in the community is 0.9-2.4 cases per 1000 aged <55 years and 7.7 per 1000 aged ≥85 years 3.
- Escherichia coli has been implicated in ≤ 75-90% of cases of out-patient uncomplicated UTIs 4.
Treatment of UTIs in Men
- Trimethoprim-sulfamethoxazole has been the preferred first-line agent for uncomplicated out-patient UTIs where local resistance is < 10 - 20% 4.
- Fluoroquinolones, such as ciprofloxacin, have become a common first-line agent in areas with increased resistance 4.
- Ciprofloxacin has been shown to be effective in treating UTIs, with a success rate of 91% in one study 5.
- A study found that 7 days of ciprofloxacin or trimethoprim-sulfamethoxazole was noninferior to 14 days in afebrile men with UTIs 6.