What is the recommended treatment for an uncomplicated urinary tract infection (UTI) in a male patient?

From the Guidelines

The recommended treatment duration for an uncomplicated urinary tract infection (UTI) in a male patient is 7-14 days, with 14 days being considered when prostatitis cannot be excluded. According to the European Association of Urology guidelines on urological infections, published in 2024 1, the treatment duration should be closely related to the treatment of the underlying abnormality. The guidelines suggest that a shorter treatment duration, such as 7 days, may be considered in certain cases, but this should be determined on an individual basis.

When selecting an antibiotic, it's essential to consider the severity of the illness, local resistance patterns, and specific host factors, such as allergies 1. The microbial spectrum for UTIs in males is greater than for uncomplicated UTIs, and antimicrobial resistance is more likely, with common species including E. coli, Proteus spp., Klebsiella spp., Pseudomonas spp., Serratia spp., and Enterococcus spp. 1.

Key considerations for treatment include:

• Completing the full course of antibiotics, even if symptoms resolve earlier
• Drinking plenty of water to help flush bacteria from the system
• Following up if symptoms don't improve within 48-72 hours
• Considering urine culture and sensitivity testing to ensure the selected antibiotic is effective against the specific bacterial strain causing the infection
• Being aware that UTIs in males are often considered complicated due to potential structural or functional abnormalities of the urinary tract, which may require extended antibiotic exposure for effective treatment 1.

From the FDA Drug Label

The overall eradication rates for pathogens of interest are presented in Table 19. The bacteriologic cure rates overall for levofloxacin and control at the test-of-cure (TOC) visit for the group of all patients with a documented pathogen at baseline (modified intent to treat or mITT) and the group of patients in the mITT population who closely followed the protocol (Microbiologically Evaluable) are summarized in Table 20 To evaluate the safety and efficacy of the higher dose and shorter course of levofloxacin, 1109 patients with cUTI and AP were enrolled in a randomized, double-blind, multicenter clinical trial conducted in the U.S. from November 2004 to April 2006 comparing levofloxacin 750 mg I. V. or orally once daily for 5 days (546 patients) with ciprofloxacin 400 mg I. V. or 500 mg orally twice daily for 10 days (563 patients). The post-therapy (test-of-cure) visit occurred 10 to 14 days after the last active dose of levofloxacin and 5 to 9 days after the last dose of active ciprofloxacin 14.8 Complicated Urinary Tract Infections and Acute Pyelonephritis: 10 Day Treatment Regimen To evaluate the safety and efficacy of the 250 mg dose, 10 day regimen of levofloxacin, 567 patients with uncomplicated UTI, mild-to-moderate cUTI, and mild-to-moderate AP were enrolled in a randomized, double-blind, multicenter clinical trial conducted in the U. S. from June 1993 to January 1995 comparing levofloxacin 250 mg orally once daily for 10 days (285 patients) with ciprofloxacin 500 mg orally twice daily for 10 days (282 patients).

The recommended treatment duration for an uncomplicated urinary tract infection (UTI) in a male patient is 5 to 10 days 2.

• The treatment duration may vary depending on the severity of the infection and the specific antibiotic used.
• It is essential to complete the full course of antibiotic treatment as prescribed by the healthcare provider to ensure effective eradication of the infection.
• The choice of antibiotic and treatment duration should be based on the results of culture and susceptibility testing, as well as local epidemiology and susceptibility patterns 3.

From the Research

Treatment Duration for Male UTI

• The recommended treatment duration for an uncomplicated urinary tract infection (UTI) in male patients is typically 7 days 4.
• First-line antibiotics for men with uncomplicated UTI include trimethoprim, trimethoprim/sulfamethoxazole, and nitrofurantoin for 7 days 4.
• However, the evidence available is insufficient to make any recommendations in relation to type and duration of antimicrobial treatment for male UTIs 5.

Antibiotic Options

• Other antibiotic options for treating UTIs in men include fluoroquinolones, such as ciprofloxacin, and oral cephalosporins, such as cephalexin or cefixime 6.
• The choice of antibiotic should be guided by urine culture and susceptibility results, as well as local resistance patterns 4, 6.

Considerations

• Men with lower UTI symptoms should always receive antibiotics, and clinicians should also consider the possibility of urethritis and prostatitis in men with UTI symptoms 4.
• Increased fluids, intake of cranberry products, and methenamine hippurate can help prevent recurrent infections 4.
• Antibiotic prophylaxis is also effective in preventing recurrence but has a risk of adverse effects and antimicrobial resistance 4.