What is the treatment for a male urinary tract infection (UTI)?

From the Guidelines

The treatment for a male urinary tract infection (UTI) typically involves a 7-14 day course of antibiotics, with the specific duration depending on the complexity of the infection and the presence of underlying conditions. For uncomplicated UTIs, a 7-day course of antibiotics such as trimethoprim-sulfamethoxazole (Bactrim, 160/800 mg twice daily), nitrofurantoin (Macrobid, 100 mg twice daily), or ciprofloxacin (Cipro, 250-500 mg twice daily) is usually prescribed 1. However, for complicated UTIs or those with fever and systemic symptoms, a longer 10-14 day course may be needed, possibly with initial intravenous antibiotics 1.

It's essential to complete the entire antibiotic course even if symptoms improve quickly. Drinking plenty of water (2-3 liters daily) helps flush bacteria from the urinary system. Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage discomfort. Men should seek prompt medical attention for UTI symptoms as they often indicate a complication like prostatitis or a structural abnormality. Unlike in women, male UTIs are less common and typically require further evaluation to identify underlying causes. If symptoms persist after treatment or recur frequently, urological evaluation with imaging or cystoscopy may be necessary to identify anatomical issues or chronic bacterial reservoirs 1.

Some key factors to consider in the treatment of male UTIs include:

• The presence of underlying conditions such as obstruction, diabetes, or immunosuppression, which can increase the risk of complicated UTIs 1
• The severity of the illness at presentation, which can guide the choice of antibiotic and duration of treatment 1
• Local resistance patterns and specific host factors, such as allergies, which can influence the selection of antimicrobial therapy 1
• The results of urine culture and susceptibility testing, which can help tailor the treatment to the specific uropathogen isolated 1

From the FDA Drug Label

To reduce the development of drug-resistant bacteria and maintain the effectiveness of sulfamethoxazole and trimethoprim tablets and other antibacterial drugs, sulfamethoxazole and trimethoprim tablets should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. Urinary Tract Infections For the treatment of urinary tract infections due to susceptible strains of the following organisms: Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii, Proteus mirabilis and Proteus vulgaris It is recommended that initial episodes of uncomplicated urinary tract infections be treated with a single effective antibacterial agent rather than the combination

The treatment for a male urinary tract infection (UTI) is with a single effective antibacterial agent, such as trimethoprim-sulfamethoxazole or ciprofloxacin, for susceptible strains of organisms like Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii, Proteus mirabilis, and Proteus vulgaris 2 3.

• Key points:
  • Use a single effective antibacterial agent for initial episodes of uncomplicated UTIs
  • Select therapy based on culture and susceptibility information when available
  • Consider local epidemiology and susceptibility patterns for empiric selection of therapy
• Treatment options:
  • Trimethoprim-sulfamethoxazole
  • Ciprofloxacin

From the Research

Treatment Options for Male UTI

• The optimal treatment duration for men with urinary tract infection (UTI) is poorly defined, but studies suggest that shorter-duration therapy may perform as well as longer-duration therapy 4.
• Empirical short-course therapy is preferred for the management of acute cystitis, but evolving resistance requires continuing reassessment of optimal antimicrobial selection 5.
• For male UTIs, fluoroquinolones were the most prescribed antibiotics (64.9%), followed by beta-lactams (17.4%), trimethoprim-sulfamethoxazole (11.9%), and nitrofurantoin (2.6%) 6.

Antibiotic Treatment Duration

• Longer-duration treatment (>7 days) for male UTI in the outpatient setting was associated with no reduction in early or late recurrence, and was associated with increased late recurrence compared with shorter-duration treatment (7).
• A study found that ciprofloxacin appears to be an effective and safe orally-administrable treatment even for complicated urinary tract infection, with cure rates at 28 days of 94% and 88% for 100 mg and 250 mg doses, respectively (8).

Diagnostic Approach

• Urine dipstick test was done in 1.8% of consultations, and urine culture was positive for Escherichia coli in 50.4% of bacteriological tests (6).
• The definition of male UTIs needs to be specified by prospective studies, and diagnostic evidence of male cystitis may reduce the duration of antibiotic therapy and spare critical antibiotics (6).