What antibiotic is recommended for a male Urinary Tract Infection (UTI)?

From the Guidelines

For a male urinary tract infection (UTI), the recommended antibiotic treatment duration is 7 to 14 days, depending on the severity of the illness and local resistance patterns, with a urine culture and susceptibility testing guiding the choice of antimicrobial agent. The choice of antibiotic should be based on the severity of the illness, local resistance patterns, and specific host factors such as allergies 1.

Commonly Prescribed Antibiotics

• Trimethoprim-sulfamethoxazole (Bactrim, Septra)
• Nitrofurantoin (Macrobid)
• Ciprofloxacin (Cipro)
• Levofloxacin (Levaquin) The most common species found in cultures of complicated UTIs include E. coli, Proteus spp., Klebsiella spp., Pseudomonas spp., Serratia spp., and Enterococcus spp., with ESBL-producing organisms and multidrug-resistant organisms being a concern 1.

Treatment Considerations

• A 7-day course may be considered for haemodynamically stable patients who have been afebrile for at least 48 hours, but a 14-day course is recommended for men when prostatitis cannot be excluded 1.
• The treatment duration should be closely related to the treatment of the underlying abnormality.
• Patients should increase fluid intake to help flush bacteria from the urinary tract and may take over-the-counter pain relievers like ibuprofen to manage discomfort.
• If symptoms don't improve within 48 hours of starting antibiotics, or if fever, back pain, or blood in urine develops, medical attention should be sought immediately as these could indicate a more serious kidney infection or prostate involvement.

From the FDA Drug Label

Levofloxacin tablets are indicated for the treatment of complicated urinary tract infections due to Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis Levofloxacin tablets are indicated for the treatment of uncomplicated urinary tract infections (mild to moderate) due to Escherichia coli, Klebsiella pneumoniae, or Staphylococcus saprophyticus.

Levofloxacin is an antibiotic that can be used to treat urinary tract infections (UTIs) in males, including:

• Complicated UTIs caused by Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis
• Uncomplicated UTIs caused by Escherichia coli, Klebsiella pneumoniae, or Staphylococcus saprophyticus 2

From the Research

Antibiotic Treatment for Male UTI

• The optimal approach for treating acute urinary tract infections (UTIs) in men is not well-defined, but some studies provide guidance on appropriate antibiotic therapies 3, 4, 5, 6, 7.
• According to a 2014 review, limited observational studies support 7 to 14 days of therapy for acute urinary tract infection in men 3.
• A 1977 study suggests that sulfonamides, trimethoprim-sulfamethoxazole, nitrofurantoin, and nalidixic acid are useful for treatment of uncomplicated lower urinary tract infections in an outpatient setting, but may not be indicated for acute upper tract infections 4.
• A 2020 study recommends knowledge of common uropathogens and local susceptibility patterns to determine appropriate empiric antibiotic therapy for UTIs, and suggests that nitrofurantoin, fosfomycin, and pivmecillinam are suitable first-line therapies for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females, but may also be considered for men 5.
• The same study notes that high rates of resistance to trimethoprim-sulfamethoxazole and ciprofloxacin preclude their use as empiric treatment of UTIs in several communities, particularly if patients have recently been exposed to them or are at risk of infections with extended-spectrum β-lactamases (ESBLs)-producing Enterobacteriales 5.
• Another 2020 study found that prior urinary infection/colonisation with trimethoprim/sulfamethoxazole-resistant Enterobacteriaceae and recent use of trimethoprim/sulfamethoxazole are predictors of resistance among urinary isolates, and suggests that a patient-specific antibiogram may allow empirical use of trimethoprim/sulfamethoxazole in patients with community-onset UTI in the absence of risk factors for resistance 7.
• A 2016 study found that Escherichia coli accounted for the vast majority of organisms isolated in patients with uncomplicated UTIs, and that resistance to trimethoprim-sulfamethoxazole was the most common antibiotic resistance, while fosfomycin was the least resistant antibiotic 6.