What is the treatment for Urinary Tract Infection (UTI) in males?

From the Guidelines

For men with a urinary tract infection (UTI), the standard treatment is a course of antibiotics, with the specific choice and duration depending on the complexity of the infection and local resistance patterns, as recommended by the European Association of Urology guidelines 1.

Treatment Options

• For uncomplicated UTIs, trimethoprim-sulfamethoxazole (Bactrim DS) or nitrofurantoin (Macrobid) may be prescribed 1.
• For more complicated infections, a combination of antibiotics such as amoxicillin plus an aminoglycoside, or a second-generation cephalosporin plus an aminoglycoside, may be used, with the strength of the recommendation determined by the balance between desirable and undesirable consequences of alternative management strategies 1.

Important Considerations

• Men with UTIs should complete the full course of antibiotics even if symptoms improve quickly, and a medical evaluation is important to rule out underlying issues such as prostate enlargement or kidney stones 1.
• The European Association of Urology guidelines emphasize the importance of antimicrobial stewardship to combat the rising threat of antimicrobial resistance, and provide recommendations for antibiotic selection, dosing, and duration based on the latest evidence 1.

Complicated UTIs

• For complicated UTIs, the guidelines recommend managing any urological abnormality and/or underlying complicating factors, and using a combination of antibiotics such as amoxicillin plus an aminoglycoside, or a second-generation cephalosporin plus an aminoglycoside 1.
• The duration of treatment should be closely related to the treatment of the underlying abnormality, and may range from 7 to 14 days, depending on the severity of the illness and local resistance patterns 1.

From the FDA Drug Label

To reduce the development of drug-resistant bacteria and maintain the effectiveness of sulfamethoxazole and trimethoprim tablets and other antibacterial drugs, sulfamethoxazole and trimethoprim tablets should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to empiric selection of therapy Urinary Tract Infections For the treatment of urinary tract infections due to susceptible strains of the following organisms: Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii, Proteus mirabilis and Proteus vulgaris CLINICAL STUDIES Complicated Urinary Tract Infection and Pyelonephritis – Efficacy in Pediatric Patients:

Men's UTI treatment can be done with:

• Trimethoprim-sulfamethoxazole (PO) for the treatment of urinary tract infections due to susceptible strains of Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii, Proteus mirabilis, and Proteus vulgaris 2
• Ciprofloxacin (PO) for the treatment of complicated urinary tract infections and pyelonephritis 3

Key points:

• The choice of antibiotic should be based on the susceptibility of the bacteria and local epidemiology
• Trimethoprim-sulfamethoxazole and ciprofloxacin are options for the treatment of urinary tract infections in men, but the specific choice depends on the individual case and the susceptibility of the bacteria 2, 3

From the Research

Men's UTI Treatment

• The optimal approach for treating acute cystitis in men is not well-defined, with limited observational studies supporting 7 to 14 days of therapy for acute urinary tract infection in men 4.
• A systematic review of the literature found that the evidence available is insufficient to make any recommendations in relation to type and duration of antimicrobial treatment for male UTIs 5.
• Fluoroquinolones are effective for clinical outcomes but should be reserved for more invasive infections, while β-Lactam agents (amoxicillin-clavulanate and cefpodoxime-proxetil) are not as effective as empirical first-line therapies 4.
• Treatment options for UTIs due to ESBLs-E coli include nitrofurantoin, fosfomycin, pivmecillinam, amoxicillin-clavulanate, finafloxacin, and sitafloxacin, while pivmecillinam, fosfomycin, finafloxacin, and sitafloxacin are treatment oral options for ESBLs- Klebsiella pneumoniae 6.
• Guidelines for the management of male urinary tract infections in primary care lack international consensus, with different classifications of mUTIs and varying durations of antibiotic treatment recommended 7.

Antibiotic Treatment

• Trimethoprim-sulfamethoxazole, nitrofurantoin, and fosfomycin are all appropriate first-line therapies for uncomplicated cystitis 4.
• Fluoroquinolones, such as ciprofloxacin and ofloxacin, have similar efficacy to trimethoprim/sulfamethoxazole when given for 3 days to treat acute, symptomatic, uncomplicated lower urinary tract infection in women 8.
• The duration of antibiotic treatment for febrile mUTIs has been gradually reduced over the last 20 years from 28 days to 10-14 days of fluoroquinolones, which has become the international gold standard 7.

Treatment Duration

• Limited observational studies support 7 to 14 days of therapy for acute urinary tract infection in men 4.
• The duration of antibiotic treatment for febrile mUTIs has been gradually reduced over the last 20 years from 28 days to 10-14 days of fluoroquinolones 7.
• Guidelines from Scandinavian countries propose short courses (3-5 days) of FQ-sparing treatments: pivmecillinam, nitrofurantoin, or trimethoprim 7.