What is the treatment guideline for uncomplicated urinary tract infections (UTIs) in men?

From the Guidelines

The treatment of uncomplicated urinary tract infections (UTIs) in men typically involves a 7-14 day course of antibiotics. According to the European Association of Urology guidelines on urological infections, published in 2024 1, the management of UTIs in men should take into account the severity of the illness, local resistance patterns, and specific host factors.

Key Considerations

• The microbial spectrum is greater than for uncomplicated UTIs, and antimicrobial resistance is more likely 1.
• E. coli, Proteus spp., Klebsiella spp., Pseudomonas spp., Serratia spp., and Enterococcus spp. are the most common species found in cultures 1.
• A urine culture and susceptibility testing should be performed to guide therapy based on susceptibility results 1.

Treatment Recommendations

• First-line therapy usually includes trimethoprim-sulfamethoxazole (TMP-SMX) or fluoroquinolones such as ciprofloxacin 1.
• The treatment duration should be closely related to the treatment of the underlying abnormality, and a shorter treatment duration (e.g., 7 days) may be considered in cases where short-course treatment is desirable 1.
• A 7-14 day course of antibiotics is generally recommended, with 14 days being recommended for men when prostatitis cannot be excluded 1.

Supportive Measures

• Adequate hydration and complete emptying of the bladder are important supportive measures during treatment.
• If symptoms persist after treatment or recur shortly after completion, further urological evaluation is recommended to rule out complications or anatomical abnormalities.

From the FDA Drug Label

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

The treatment guideline for uncomplicated urinary tract infections (UTIs) in men is levofloxacin.

• The drug is indicated for the treatment of uncomplicated urinary tract infections (mild to moderate) due to Escherichia coli, Klebsiella pneumoniae, or Staphylococcus saprophyticus 2.
• Levofloxacin is a suitable treatment option for male UTI patients with the above-mentioned pathogens.

From the Research

Treatment Guidelines for Uncomplicated Urinary Tract Infections (UTIs) in Men

• The treatment of uncomplicated UTIs in men involves the use of antibiotics, with the choice of antibiotic depending on various factors such as the severity of the infection, the patient's medical history, and the local resistance patterns of the bacteria 3, 4.
• According to the guidelines, fluoroquinolones, such as ciprofloxacin, are recommended for the treatment of uncomplicated UTIs in men, especially in areas where the incidence of resistance to other antibiotics is high 5, 6.
• Other antibiotics, such as trimethoprim/sulfamethoxazole, nitrofurantoin, and pivmecillinam, may also be used, but their effectiveness may be limited by resistance patterns in certain regions 4, 7.
• The duration of treatment typically ranges from 5 to 14 days, depending on the severity of the infection and the patient's response to treatment 5, 7.

Antibiotic Resistance and Treatment Options

• The increasing prevalence of antibiotic-resistant bacteria, such as extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, has limited the treatment options for UTIs 7.
• In cases where the infection is caused by resistant bacteria, alternative antibiotics such as cephalosporins, carbapenems, or fosfomycin may be used 7.
• The use of new antimicrobial agents, such as ceftazidime-avibactam and meropenem/vaborbactam, may also be considered for the treatment of UTIs caused by multidrug-resistant organisms 7.

Recommendations for Empiric Treatment

• The recommended first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in men is a 5-day course of nitrofurantoin, a 3-g single dose of fosfomycin tromethamine, or a 5-day course of pivmecillinam 7.
• Second-line options include oral cephalosporins, such as cephalexin or cefixime, fluoroquinolones, and beta-lactams, such as amoxicillin-clavulanate 7.
• It is essential to consider the local resistance patterns and the patient's medical history when selecting an antibiotic for empiric treatment 3, 4, 7.