What is the recommended antibiotic for a male with Benign Prostatic Hyperplasia (BPH) who has a Urinary Tract Infection (UTI)?

From the Guidelines

For a male with Benign Prostatic Hyperplasia (BPH) who has a Urinary Tract Infection (UTI), the recommended antibiotic treatment should be based on the severity of the illness and local resistance patterns, with a strong consideration for managing any urological abnormality and/or underlying complicating factors 1. When considering the treatment options, it's crucial to note that the European Association of Urology guidelines suggest using a combination of antibiotics for complicated UTIs, such as amoxicillin plus an aminoglycoside or a second-generation cephalosporin plus an aminoglycoside, and reserving ciprofloxacin for cases where the local resistance rate is <10% and the patient does not require hospitalization 1. Some key points to consider in the management of UTI in males with BPH include:

• The microbial spectrum is broader than in uncomplicated UTIs, with a higher likelihood of antimicrobial resistance 1.
• Common pathogens include E. coli, Proteus spp., Klebsiella spp., Pseudomonas spp., Serratia spp., and Enterococcus spp. 1.
• Treatment duration should be tailored to the individual case, but generally ranges from 7 to 14 days, with the possibility of extending treatment if there are signs of prostate involvement 1.
• It is essential to manage any urological abnormality and/or underlying complicating factors, and to consider the use of alpha-blockers like tamsulosin to improve urinary flow and help clear the infection 1. Given the complexity of UTIs in males with BPH and the potential for complications, the most appropriate initial empiric therapy should be guided by local resistance patterns and the severity of the illness, with a preference for combination therapy as outlined in the European Association of Urology guidelines 1.

From the FDA Drug Label

1. 8 Chronic Bacterial Prostatitis Levofloxacin tablets are indicated for the treatment of chronic bacterial prostatitis due to Escherichia coli, Enterococcus faecalis, or methicillin-susceptible Staphylococcus epidermidis
2. 6 Chronic Bacterial Prostatitis Adult patients with a clinical diagnosis of prostatitis and microbiological culture results from urine sample collected after prostatic massage (VB3) or expressed prostatic secretion (EPS) specimens obtained via the Meares-Stamey procedure were enrolled in a multicenter, randomized, double-blind study comparing oral levofloxacin 500 mg, once daily for a total of 28 days to oral ciprofloxacin 500 mg, twice daily for a total of 28 days.

Levofloxacin is recommended for the treatment of Chronic Bacterial Prostatitis due to Escherichia coli, Enterococcus faecalis, or methicillin-susceptible Staphylococcus epidermidis.

• The recommended dose is 500 mg once daily for 28 days.
• The microbiologic eradication rate by patient infection at 5 to 18 days after completion of therapy was 75% in the levofloxacin group 2.
• Clinical success (cure + improvement with no need for further antibiotic therapy) rates in microbiologically evaluable population 5 to 18 days after completion of therapy were 75% for levofloxacin-treated patients 2.

From the Research

Antibiotic Treatment for UTI in Males with BPH

The recommended antibiotic treatment for a male with Benign Prostatic Hyperplasia (BPH) who has a Urinary Tract Infection (UTI) depends on various factors, including the severity of the infection, the presence of complications, and the local susceptibility patterns of uropathogens.

• The choice of antibiotic should be based on the results of urine culture and susceptibility testing, if available 3.
• For uncomplicated UTIs in males, fluoroquinolones such as ciprofloxacin, levofloxacin, and norfloxacin have been shown to be effective 4, 5.
• However, the use of fluoroquinolones should be guided by local resistance patterns and individual patient factors, such as the presence of extended-spectrum β-lactamases (ESBLs)-producing Enterobacteriales 6.
• Oral cephalosporins, such as cephalexin and cefixime, are alternative options for the treatment of UTIs in males, including those with BPH 6, 7.
• For complicated UTIs, including those associated with BPH, the treatment should be guided by the severity of the infection and the presence of underlying abnormalities, such as bladder outlet obstruction (BOO) 3.

Considerations for Antibiotic Selection

When selecting an antibiotic for the treatment of UTI in males with BPH, the following factors should be considered:

• Local susceptibility patterns of uropathogens 6, 3
• Presence of complications, such as BOO or recurrent UTIs 3
• Individual patient factors, such as the presence of ESBLs-producing Enterobacteriales or carbapenem-resistant Enterobacteriales 6
• Potential for antibiotic resistance and the need for antibiotic stewardship 6, 3