From the Guidelines
Ceftriaxone alone is typically not sufficient to fully treat a urinary tract infection (UTI) in males, and a combination of intravenous ceftriaxone followed by a course of oral antibiotics is recommended. The most recent and highest quality study, published in 2024 in JAMA Network Open 1, provides guidelines for the treatment of UTIs, including the use of ceftriaxone as an empirical choice for patients who require intravenous therapy. However, this study also notes that the selection of empirical treatment regimens should be based on local resistance rates and the presence of risk factors for antimicrobial resistance.
Recommended Approach
The recommended approach for treating a UTI in males is:
- Start with a single dose of intravenous or intramuscular ceftriaxone (1-2 grams) to provide rapid initial coverage against many UTI-causing bacteria.
- Follow this with a 7-14 day course of oral antibiotics, such as ciprofloxacin (500 mg twice daily) or trimethoprim-sulfamethoxazole (160/800 mg twice daily), to ensure complete eradication of the infection and prevent recurrence.
Rationale
This two-step approach is necessary because:
- Ceftriaxone provides rapid initial coverage against many UTI-causing bacteria, but may not be sufficient to fully treat the infection on its own.
- The oral antibiotic course ensures complete eradication of the infection and prevents recurrence, which is particularly important in males who may be at higher risk of complications due to anatomical differences.
Importance of Completing Treatment
It's crucial to complete the full course of antibiotics even if symptoms improve, as stopping treatment early can lead to recurrence or the development of antimicrobial resistance. If symptoms persist after treatment, further evaluation may be needed to rule out complications like prostatitis or structural abnormalities, as noted in a study published in 2023 in Clinical Microbiology and Infection 1.
From the FDA Drug Label
Urinary Tract Infections (complicated and uncomplicated) caused by Escherichia coli, Proteus mirabilis, Proteus vulgaris, Morganella morganii or Klebsiella pneumoniae
- Ceftriaxone is indicated for the treatment of urinary tract infections
- The drug label does not specify any differences in treatment for male or female patients with UTIs
- Ceftriaxone may be sufficient to treat a urinary tract infection (UTI) in a male, if the causative organism is susceptible to the drug 2
From the Research
Treatment of Urinary Tract Infections (UTIs) in Males
- The treatment of UTIs in males typically involves antibiotics, with the choice of antibiotic guided by urine culture and susceptibility results 3.
- First-line antibiotics for men with uncomplicated UTI include trimethoprim, trimethoprim/sulfamethoxazole, and nitrofurantoin for seven days 3.
- Ceftriaxone, a third-generation cephalosporin, is not typically recommended as a first-line treatment for uncomplicated UTIs due to the risk of promoting antibiotic resistance and increasing the risk of Clostridioides difficile infection 4.
Use of Ceftriaxone in Treating UTIs
- Ceftriaxone has been shown to have high susceptibility rates against common uropathogens, but its use is associated with a higher risk of hospital-onset Clostridioides difficile infection compared to other antibiotics such as cefazolin 4.
- There is limited evidence to support the use of ceftriaxone as a first-line treatment for uncomplicated UTIs in males, and its use should be guided by local susceptibility data and individual patient factors 4, 5, 6, 7.
Alternative Treatment Options
- Other antibiotics such as cephalexin have been shown to be effective in treating uncomplicated UTIs, with high clinical success rates and low rates of adverse effects 6.
- The choice of antibiotic should be guided by local susceptibility data, patient factors, and the severity of the infection 3, 5, 7.