What is the treatment for a male patient with a urinary tract infection (UTI) presenting with hematuria?

From the Guidelines

To treat a male urinary tract infection (UTI) with hematuria, antibiotics such as trimethoprim-sulfamethoxazole (Bactrim DS) 1 tablet twice daily for 7-14 days, ciprofloxacin 500mg twice daily for 7 days, or nitrofurantoin 100mg four times daily for 7 days should be prescribed, with the duration of treatment closely related to the treatment of the underlying abnormality and consideration of local resistance patterns and specific host factors 1.

Key Considerations

• The presence of hematuria with a UTI indicates potential kidney involvement or other complications that require professional assessment 1.
• Men with UTIs often need longer antibiotic courses than women because infections may involve the prostate gland, which requires more thorough treatment 1.
• A urine culture and susceptibility testing should be performed to guide the choice of antibiotic and duration of treatment 1.
• The European Association of Urology guidelines recommend treatment for 7-14 days, with the option for shorter treatment durations (e.g., 7 days) in certain cases, such as when the patient is hemodynamically stable and has been afebrile for at least 48 hours 1.

Treatment Approach

• Increase fluid intake to help flush bacteria from the urinary tract.
• Take over-the-counter pain relievers like acetaminophen for discomfort.
• Avoid alcohol and caffeine as these can irritate the bladder.
• If symptoms worsen, including high fever, severe pain, or increasing blood in urine, seek emergency care as these could indicate a kidney infection or other serious conditions requiring immediate attention.

Recent Evidence

• A study published in 2023 found that short-duration antibiotic therapy (5-7 days) can be effective for complicated UTIs, including in men, but more data are needed to confirm this finding 1.
• The 2024 European Association of Urology guidelines provide updated recommendations for the treatment of urological infections, including UTIs with hematuria 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Treatment of Male UTI with Hematuria

• The treatment of male urinary tract infections (UTIs) with hematuria is not specifically addressed in the provided studies, but the management of male UTIs in general is discussed 2, 3.
• According to a study published in 2021, fluoroquinolones were the most prescribed antibiotics for male UTIs, followed by beta-lactams, trimethoprim-sulfamethoxazole, and nitrofurantoin 2.
• Another study published in 2021 compared the efficacy and safety of levofloxacin and ciprofloxacin in the treatment of UTIs and found that both drugs were effective and safe, but with no significant difference between them 4, 5.
• A systematic review and meta-analysis published in 2021 also found that levofloxacin and ciprofloxacin had similar efficacy and safety in the treatment of UTIs 5.
• A study published in 2015 found that ciprofloxacin was a safe and effective therapeutic alternative for the treatment of acute or complicated UTIs in adults 6.
• The guidelines for the management of male UTIs in primary care vary internationally, with different classifications and treatment approaches 3.
• The duration of antibiotic treatment for febrile male UTIs has been gradually reduced over the last 20 years, with fluoroquinolones becoming the international gold standard 3.
• However, there is a lack of international consensus on the management of male UTIs, and more research is needed to establish evidence-based guidelines 3.

Antibiotic Treatment

• Fluoroquinolones, such as levofloxacin and ciprofloxacin, are commonly used to treat male UTIs 2, 4, 5.
• Beta-lactams, trimethoprim-sulfamethoxazole, and nitrofurantoin are also used to treat male UTIs, although less frequently than fluoroquinolones 2.
• The choice of antibiotic and duration of treatment may depend on the severity of the infection, the presence of fever, and the patient's medical history 3.

Hematuria

• Hematuria, or blood in the urine, is a symptom that may be associated with male UTIs, but the treatment of hematuria is not specifically addressed in the provided studies.
• The presence of hematuria may indicate a more severe infection or underlying condition, and further evaluation and treatment may be necessary 2.