From the Guidelines
Treatment for a male urinary tract infection (UTI) typically involves antibiotics, with a recommended duration of 7 to 14 days, depending on the severity of the illness and local resistance patterns 1. The most common first-line treatment is trimethoprim-sulfamethoxazole (Bactrim DS) taken as one tablet twice daily for 7 days, or nitrofurantoin (Macrobid) 100mg twice daily for 5-7 days. For more severe infections, fluoroquinolones like ciprofloxacin 500mg twice daily for 7 days may be prescribed. Some key points to consider when treating male UTIs include:
- The microbial spectrum is greater than for uncomplicated UTIs, and antimicrobial resistance is more likely 1
- Appropriate management of the urological abnormality or the underlying complicating factor is mandatory 1
- A urine culture and susceptibility testing should be performed, and initial empiric therapy should be tailored and followed by (oral) administration of an appropriate antimicrobial agent for the uropathogen isolated 1
- Treatment duration should be closely related to the treatment of the underlying abnormality, and when the patient is haemodynamically stable and has been afebrile for at least 48 h, a shorter treatment duration (eg, 7 d) may be considered 1
- Recent studies suggest that short-duration courses of antibiotics may be effective for the treatment of complicated UTI in men, with one study finding that a 7-day treatment course of either fluoroquinolones or trimethoprim/sulfamethoxazole was non-inferior to the 14-day treatment course 1 While waiting for antibiotics to take effect, drinking plenty of water helps flush bacteria from the urinary system. Over-the-counter pain relievers such as ibuprofen or acetaminophen can help manage discomfort. Men should complete the full course of antibiotics even if symptoms improve quickly, as stopping early can lead to recurrent infection or antibiotic resistance. UTIs in men are less common than in women and may indicate an underlying issue like prostate enlargement or kidney stones, so medical evaluation is important, especially for recurrent infections. If symptoms worsen or don't improve within 48 hours of starting antibiotics, contact a healthcare provider for further evaluation.
From the FDA Drug Label
- 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 [see Clinical Studies (14.6)].
- 9 Complicated Urinary Tract Infections: 5 Day Treatment Regimen Levofloxacin tablets are indicated for the treatment of complicated urinary tract infections due to Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis [see Clinical Studies (14.7)].
- 10 Complicated Urinary Tract Infections: 10 Day Treatment Regimen Levofloxacin tablets are indicated 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 [see Clinical Studies (14.8)].
- 11 Acute Pyelonephritis: 5 or 10 Day Treatment Regimen Levofloxacin tablets are indicated for the treatment of acute pyelonephritis caused by Escherichia coli, including cases with concurrent bacteremia [see Clinical Studies (14.7,14.8)].
- 12 Uncomplicated Urinary Tract Infections 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 options for a male Urinary Tract Infection (UTI) include:
- Levofloxacin for the treatment of:
- Chronic bacterial prostatitis due to Escherichia coli, Enterococcus faecalis, or methicillin-susceptible Staphylococcus epidermidis
- Complicated urinary tract infections due to Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis
- Complicated urinary tract infections (mild to moderate) due to Enterococcus faecalis, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Pseudomonas aeruginosa
- Acute pyelonephritis caused by Escherichia coli, including cases with concurrent bacteremia
- Uncomplicated urinary tract infections (mild to moderate) due to Escherichia coli, Klebsiella pneumoniae, or Staphylococcus saprophyticus 2, 2, 2
From the Research
Treatment Options for Male Urinary Tract Infections (UTIs)
- The treatment options for male UTIs include various antibiotics, such as nitrofurantoin, ciprofloxacin, amoxicillin/clavulanic acid, and trimethoprim/sulfamethoxazole 3.
- A study found that nitrofurantoin failure was common in males with uncomplicated UTI and increased with age 3.
- Another study demonstrated that males with UTIs may be successfully treated with an outpatient 5-day course of levofloxacin, which is a shorter course of antimicrobial therapy than previously recommended 4.
- The optimal approach for treating acute cystitis in men is not well defined, but limited observational studies support 7 to 14 days of therapy for acute urinary tract infection in men 5.
Antibiotic Treatment Duration and Effectiveness
- A systematic review of the literature found that the evidence available is insufficient to make any recommendations in relation to type and duration of antimicrobial treatment for male UTIs 6.
- However, the review found that for 75% of males with a UTI, bacteriological cure was reported at the end of the study, and 97% of patients receiving a fluoroquinolone reported bacteriological and clinical cure within 2 weeks after treatment 6.
- Another study found that fluoroquinolones and cefalexin were associated with lower antibiotic switch rates than the recommended UTI antibiotics (pivmecillinam, nitrofurantoin, and trimethoprim) 7.