Is there a treatment with antibiotics for men with Benign Prostatic Hyperplasia (BPH) and recurrent Urinary Tract Infections (UTIs)?

From the Guidelines

Surgery is the recommended treatment for men with Benign Prostatic Hyperplasia (BPH) and recurrent Urinary Tract Infections (UTIs), as stated in the 2003 AUA guideline on management of BPH 1. When considering treatment options for men with BPH and recurrent UTIs, it's essential to prioritize the underlying cause of the infections, which is often related to urinary retention caused by prostatic enlargement.

• The 2003 AUA guideline recommends surgery for patients with recurrent UTIs, recurrent gross hematuria, or bladder stones clearly due to BPH and refractory to other therapies 1.
• Medical therapy, including antibiotics, may be considered in some cases, but it is not the first-line treatment for recurrent UTIs in men with BPH.
• Before considering antibiotic therapy, it's crucial to address the underlying BPH through appropriate management with alpha-blockers, 5-alpha reductase inhibitors, or surgical interventions if indicated.
• Patients with recurrent UTIs should be monitored for antibiotic resistance, side effects, and efficacy during treatment, and simple measures like increased fluid intake, complete bladder emptying, and post-void residual volume assessments should be implemented alongside any treatment.
• The use of prophylactic antibiotics, such as low-dose trimethoprim-sulfamethoxazole, nitrofurantoin, or ciprofloxacin, may be considered for men experiencing frequent UTIs, but this should be done under close supervision and with careful consideration of the potential risks and benefits. The primary goal of treatment should be to alleviate the underlying cause of the UTIs, which is often related to the BPH, rather than just treating the symptoms with antibiotics 1.

From the Research

Treatment Options for BPH and UTIs

• There is no direct evidence to suggest the use of antibiotics as a treatment for men with Benign Prostatic Hyperplasia (BPH) and recurrent Urinary Tract Infections (UTIs) 2, 3, 4, 5, 6.
• However, studies suggest that medical therapy, including 5-alpha reductase inhibitors and alpha-blockers, can be effective in managing BPH symptoms and reducing the risk of complications such as urinary retention and need for surgical intervention 3, 4, 5, 6.
• The use of 5-alpha reductase inhibitors, such as finasteride and dutasteride, can reduce prostate volume, improve lower urinary tract symptoms, and decrease the risk of acute urinary retention and need for surgical intervention 3, 5.
• Alpha-blockers, such as doxazocin, terazosin, tamsulosin, and alfuzosin, can relax the smooth muscle of the bladder neck and prostate, improving urine flow and reducing symptoms 3, 4.
• Combination therapy, using both 5-alpha reductase inhibitors and alpha-blockers, can provide short-term symptom relief and long-term disease management 4, 6.

Management of UTIs in BPH Patients

• While there is no direct evidence on the use of antibiotics for BPH and UTIs, it is likely that antibiotics would be used to treat recurrent UTIs in men with BPH, as UTIs are a common complication of BPH 2, 3.
• The management of UTIs in BPH patients would likely involve a combination of medical therapy to manage BPH symptoms and antibiotic therapy to treat the UTI 4, 5.