From the Guidelines
For treating a male urinary tract infection (UTI) caused by coagulase-negative staphylococcus, the recommended first-line treatment is typically trimethoprim-sulfamethoxazole (TMP-SMX, or Bactrim) at a dose of 160/800 mg (one double-strength tablet) twice daily for 7-14 days, as suggested by the European Association of Urology guidelines 1. Alternative options include nitrofurantoin 100 mg four times daily for 7 days, or fluoroquinolones such as ciprofloxacin 500 mg twice daily for 7 days if the organism is susceptible.
The exact antibiotic choice should be guided by susceptibility testing, as resistance patterns vary 1. Males with UTIs generally require longer treatment courses than females due to anatomical differences and the potential for deeper tissue involvement. It's essential to ensure adequate hydration during treatment by drinking plenty of water.
If symptoms persist after treatment, or if there are complicating factors like fever, back pain, or recurrent infections, further evaluation for underlying conditions such as prostatitis, urinary obstruction, or anatomical abnormalities may be necessary 1. Coagulase-negative staphylococci are typically less virulent than Staphylococcus aureus but can cause significant infections, especially in the presence of urinary catheters or other risk factors.
Key considerations in managing UTIs include:
- Identifying and addressing underlying complicating factors, such as obstruction or immunosuppression 1
- Selecting antibiotics based on local resistance patterns and susceptibility testing 1
- Ensuring adequate treatment duration, typically 7-14 days for males 1
- Monitoring for signs of complications or treatment failure, and adjusting the treatment plan as needed 1
From the Research
Treatment Options for Negative Staphylococcus in Male UTI
- The treatment of urinary tract infections (UTIs) caused by Staphylococcus species can be challenging due to antibiotic resistance 2, 3.
- A case study reported the successful treatment of a Staphylococcus haemolyticus UTI in a male patient using trimethoprim-sulfamethoxazole 2.
- However, the use of trimethoprim-sulfamethoxazole may not be suitable for all cases, as resistance rates to this antibiotic are high 4, 5.
- Alternative treatment options for UTIs caused by Staphylococcus species may include nitrofurantoin, fosfomycin, and amoxicillin-clavulanate 5, 6.
- The choice of antibiotic should be guided by local susceptibility patterns and the specific characteristics of the patient, such as the presence of underlying medical conditions or recent antibiotic use 5, 6.
Antibiotic Susceptibility Patterns
- Staphylococcus aureus is isolated in around 0.2%-4% of positive urinary cultures, and may be linked to S. aureus bacteraemia 3.
- The susceptibility patterns of Staphylococcus species to various antibiotics can vary, with some studies reporting high resistance rates to certain antibiotics 4, 5.
- Nitrofurantoin and amoxicillin-clavulanate have been shown to have high susceptibility rates against non-ESBL E. coli, making them potential options for empiric treatment of UTIs 6.
- Fosfomycin has also been reported to have low resistance rates, making it a viable option for the treatment of UTIs caused by Staphylococcus species 4, 5.
Treatment Algorithms
- A simple algorithm to guide clinicians in the treatment of UTIs caused by Staphylococcus species has been proposed, taking into account factors such as the presence of underlying medical conditions and recent antibiotic use 3.
- The algorithm recommends repeat urine culture and investigation and treatment of higher risk patients, such as those with urinary catheterization or urological abnormalities 3.
- The development of a UTI empiric treatment algorithm tailored towards specific patient populations, such as those in long-term care facilities, may be necessary to ensure effective treatment and minimize antibiotic resistance 6.