Oral Antibiotics for UTI in Men
For uncomplicated urinary tract infections (UTIs) in men, a 14-day course of fluoroquinolones (ciprofloxacin 500-750 mg twice daily or levofloxacin 750 mg once daily) is recommended as first-line therapy when local fluoroquinolone resistance is <10%. 1
First-Line Treatment Options
When selecting an oral antibiotic for UTIs in men, consider the following options:
Fluoroquinolones (when local resistance <10%):
- Ciprofloxacin: 500-750 mg twice daily for 14 days
- Levofloxacin: 750 mg once daily for 14 days
Alternative options:
- Trimethoprim-sulfamethoxazole (TMP-SMX): 160/800 mg twice daily for 14 days
Important Considerations
- All UTIs in men are considered complicated: According to the European Association of Urology guidelines, male gender is a factor that classifies UTIs as complicated 2
- Treatment duration: A 14-day course is generally recommended for men, particularly when prostatitis cannot be excluded 2, 1
- Urine culture: Always obtain a urine culture before initiating antibiotics to guide therapy 1
- Resistance patterns: Consider local resistance patterns when selecting empiric therapy 1
Special Situations
Renal Impairment
If using levofloxacin in patients with impaired renal function, adjust dosing based on creatinine clearance:
- ≥50 mL/min: 750 mg once daily (normal dose)
- 20-49 mL/min: 500 mg once daily
- 10-19 mL/min: 250 mg once daily
- Hemodialysis or Peritoneal Dialysis: 250-500 mg every 48 hours (dose post-HD on dialysis days) 1
Multidrug-Resistant Organisms
For patients at risk of infections with extended-spectrum β-lactamases (ESBLs)-producing organisms:
- Avoid empiric use of TMP-SMX and fluoroquinolones if patient was recently exposed to these agents 3
- Consider alternative agents based on susceptibility testing
Monitoring and Follow-up
- Assess clinical response within 48-72 hours of initiating therapy
- Perform follow-up urine culture 1-2 weeks after completing treatment if symptoms persist 1
- Consider urological evaluation for structural abnormalities in men with recurrent UTIs 1
Common Pitfalls to Avoid
- Treating for too short a duration: Male UTIs require longer treatment (14 days) compared to uncomplicated UTIs in women 1
- Not obtaining urine cultures: Always collect cultures before starting antibiotics 1
- Overlooking prostatitis: Consider the possibility of concurrent prostatitis in male UTIs 1
- Ignoring local resistance patterns: Local antibiotic resistance should guide empiric therapy choices 2, 1
By following these guidelines, clinicians can optimize treatment outcomes and reduce the risk of complications and recurrence in men with UTIs.