What is the empiric antibiotic coverage for Urinary Tract Infections (UTI) in men?

From the Guidelines

For empiric treatment of urinary tract infections (UTIs) in men, the recommended first-line therapy is a fluoroquinolone, such as ciprofloxacin 500 mg twice daily for 7 days or levofloxacin 750 mg once daily for 5-7 days, or trimethoprim-sulfamethoxazole (TMP-SMX) 160/800 mg twice daily for 7-14 days. This recommendation is based on the most recent and highest quality study available, which suggests that short-duration courses of antibiotics are effective for the management of complicated UTI and pyelonephritis in men 1. The choice of antibiotic should be guided by local resistance patterns and the severity of the infection. Some key points to consider when treating UTIs in men include:

• Obtaining a urine culture to guide definitive therapy 1
• Considering the risk of resistant organisms and adjusting the antibiotic choice accordingly 1
• Being aware that men with UTIs may have underlying anatomic abnormalities, prostate involvement, or foreign bodies that may contribute to the infection 1
• Using fluoroquinolones with caution due to their potential for adverse effects 1
• Considering alternative antibiotics, such as TMP-SMX, in areas with high fluoroquinolone resistance 1. It is essential to note that the treatment duration for UTIs in men is typically longer than in women, ranging from 7-14 days, due to the higher likelihood of complicated infections in men 1.

From the FDA Drug Label

1.9 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 1.10 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 1.11 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 1.12 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 empiric antibiotic coverage for Urinary Tract Infections (UTI) in men includes:

• Levofloxacin for complicated UTIs due to Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis, Enterobacter cloacae, or Pseudomonas aeruginosa 2
• Levofloxacin for acute pyelonephritis caused by Escherichia coli 2
• Levofloxacin for uncomplicated UTIs due to Escherichia coli, Klebsiella pneumoniae, or Staphylococcus saprophyticus 2

From the Research

Empiric Antibiotic Coverage for Urinary Tract Infections (UTI) in Men

• The recommended empiric antibiotic therapy for UTIs in men is not well established, but several studies provide guidance on treatment options 3, 4, 5, 6, 7.
• A study published in 2016 found that males with UTIs may be successfully treated with a 5-day course of levofloxacin, which is a shorter course of antimicrobial therapy than previously recommended 3.
• Another study published in 2012 discussed the role of fluoroquinolones in the management of UTIs in areas with high rates of fluoroquinolone-resistant uropathogens, highlighting the need for prudent use of these antibiotics 4.
• A 2020 study provided an overview of treatment options for UTIs, including those caused by antibiotic-resistant Gram-negative bacteria, and emphasized the importance of using new antimicrobials wisely to avoid resistance development 5.
• A 2017 study updated the management of UTIs in the era of antimicrobial resistance, highlighting the need for judicious use of antibiotics and knowledge of local susceptibility patterns to determine appropriate empiric therapy 6.
• A systematic review published in 2021 found that the evidence available is insufficient to make recommendations on the type and duration of antimicrobial treatment for male UTIs, and called for sufficiently powered randomized controlled trials to identify the best treatment options 7.

Treatment Options

• Fluoroquinolones, such as levofloxacin and ciprofloxacin, are potential treatment options for UTIs in men, but their use should be restricted due to increasing rates of resistance 4, 5, 6.
• Other treatment options for UTIs in men include nitrofurantoin, fosfomycin, and beta-lactam antibiotics, such as amoxicillin-clavulanate and cefepime 5, 6.
• For UTIs caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, treatment options include carbapenems, ceftazidime-avibactam, and ceftolozane-tazobactam 5, 6.
• For UTIs caused by carbapenem-resistant Enterobacteriaceae (CRE), treatment options include ceftazidime-avibactam, colistin, and tigecycline 5, 6.