What antibiotics are used to treat urinary tract infections (UTIs) in men?

From the Guidelines

For urinary tract infections in men, the recommended antibiotics include amoxicillin plus an aminoglycoside, a second-generation cephalosporin plus an aminoglycoside, or an intravenous third-generation cephalosporin as empirical treatment for complicated UTI with systemic symptoms, as per the European Association of Urology guidelines 1. When treating urinary tract infections (UTIs) in men, it's crucial to consider the severity and complexity of the infection.

• For complicated UTIs, the guidelines suggest using a combination of antibiotics, such as amoxicillin plus an aminoglycoside or a second-generation cephalosporin plus an aminoglycoside 1.
• In cases where the patient has systemic symptoms, an intravenous third-generation cephalosporin may be used as empirical treatment 1.
• The use of ciprofloxacin is only recommended if the local resistance rate is less than 10%, and the patient does not require hospitalization, or has anaphylaxis to beta-lactam antimicrobials 1. It's essential to manage any underlying urological abnormalities and complicating factors to ensure effective treatment 1. In general, men with UTIs require longer treatment courses than women, typically ranging from 7-14 days, due to the deeper tissue involvement, such as the prostate 1.

From the FDA Drug Label

1.9 Complicated Urinary Tract Infections: 5-day Treatment Regimen Levofloxacin tablets are indicated in adult patients for the treatment of complicated urinary tract infections due to Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis 1.10 Complicated Urinary Tract Infections: 10-day Treatment Regimen Levofloxacin tablets are indicated in adult patients for the treatment of complicated urinary tract infections (mild to moderate) due to Enterococcus faecalis, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Pseudomonas aeruginosa 1.11 Acute Pyelonephritis: 5 or 10-day Treatment Regimen Levofloxacin tablets are indicated in adult patients for the treatment of acute pyelonephritis caused by Escherichia coli, including cases with concurrent bacteremia 1.12 Uncomplicated Urinary Tract Infections Levofloxacin tablets are indicated in adult patients for the treatment of uncomplicated urinary tract infections (mild to moderate) due to Escherichia coli, Klebsiella pneumoniae, or Staphylococcus saprophyticus.

Antibiotics for Urinary Tract Infections (UTIs) in Men:

• Levofloxacin is used to treat complicated and uncomplicated UTIs due to Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis, Staphylococcus saprophyticus, and other bacteria.
• The treatment regimen may vary from 5 to 10 days, depending on the severity and type of infection.
• It is essential to note that levofloxacin should be reserved for patients with no alternative treatment options due to the potential for serious adverse reactions 2.

From the Research

Antibiotics for Urinary Tract Infections in Men

• The following antibiotics are used to treat urinary tract infections (UTIs) in men:
  • Nitrofurantoin 3, 4, 5
  • Norfloxacin 6
  • Sulfamethoxazole and trimethoprim (co-trimoxazole) 6, 7
  • Ciprofloxacin 6, 7
  • Cefpodoxime 5
  • Ceftriaxone 5
  • Amoxicillin-clavulanate 4, 5
  • Fosfomycin 4
  • Pivmecillinam 4
• The choice of antibiotic depends on the severity of the infection, the patient's medical history, and the susceptibility of the bacteria to different antibiotics.
• It is essential to use antibiotics wisely to avoid the development of resistance 4.
• A 7-day course of antibiotic therapy may be sufficient for treating UTIs in men, as it has been shown to be noninferior to a 14-day course in terms of symptom resolution 7.

First-Line and Second-Line Treatment Options

• First-line treatment options for uncomplicated UTIs in men include:
  • Nitrofurantoin 3, 4, 5
  • Norfloxacin 6
• Second-line treatment options include:
  • Oral cephalosporins such as cephalexin or cefixime 4
  • Fluoroquinolones 4
  • β-lactams such as amoxicillin-clavulanate 4

Treatment of Complicated UTIs

• For UTIs caused by extended-spectrum β-lactamases (ESBLs)-producing Enterobacteriales, treatment options include:
  • Nitrofurantoin 4
  • Fosfomycin 4
  • Pivmecillinam 4
  • Fluoroquinolones 4
  • Cefepime 4
  • Piperacillin-tazobactam 4
  • Carbapenems 4
• For UTIs caused by carbapenem-resistant Enterobacteriales (CRE), treatment options include:
  • Ceftazidime-avibactam 4
  • Meropenem/vaborbactam 4
  • Imipenem/cilastatin-relebactam 4
  • Colistin 4
  • Fosfomycin 4
  • Aztreonam 4
  • Amoxicillin-clavulanate 4
  • Aminoglycosides including plazomicin 4
  • Cefiderocol 4
  • Tigecycline 4