What is the recommended treatment for uncomplicated urinary tract infections (UTIs) in men?

Treatment of Uncomplicated Urinary Tract Infections in Men

For uncomplicated urinary tract infections (UTIs) in men, the recommended first-line treatment is trimethoprim-sulfamethoxazole (TMP-SMX) 160/800 mg twice daily for 7 days, provided local resistance is <20%. 1

First-Line Treatment Options

The treatment of UTIs in men should follow these evidence-based recommendations:

1. First-line antibiotics:

   • Trimethoprim-sulfamethoxazole (TMP-SMX) 160/800 mg twice daily for 7 days 1, 2
   • Nitrofurantoin 100 mg twice daily for 7 days (contraindicated if CrCl <30 mL/min) 1
   • Fosfomycin 3 g single dose (convenient option when adherence is a concern) 1

2. Alternative options (when first-line agents cannot be used):

   • Cephalexin 500 mg four times daily for 7 days 1
   • Amoxicillin-clavulanate (based on susceptibility testing) 1
   • Fluoroquinolones (should be reserved as last resort due to risk of adverse effects and increasing resistance) 1

Treatment Duration for Men

While uncomplicated UTIs in women can often be treated with shorter courses (3-5 days), men typically require longer treatment durations:

• 7 days is generally recommended for uncomplicated UTIs in men 1
• 7-14 days may be considered for complicated cases 1

This longer duration reflects the different urinary tract anatomy in men and the higher likelihood of complicating factors such as prostatitis.

Diagnostic Approach

Before initiating treatment:

• Obtain urinalysis and urine culture with sensitivity testing 1
• Treatment may be started empirically while awaiting culture results 1
• Consider local antibiogram patterns when selecting empiric therapy 1

Special Considerations

• Renal function: Avoid nitrofurantoin if CrCl <30 mL/min 1
• Fluoroquinolone use: Reserve for cases where other options cannot be used due to high risk of adverse effects 1
• Local resistance patterns: TMP-SMX should only be used if local resistance is <20% 1, 2
• Dose adjustments: For patients with impaired renal function, appropriate dose adjustments should be made 1

Common Pitfalls to Avoid

1. Treating asymptomatic bacteriuria: This should be avoided except in specific circumstances (pregnancy, urologic procedures) 1

2. Using fluoroquinolones as first-line therapy: This increases risk of adverse effects and promotes resistance 1

3. Prolonged antibiotic courses: These do not improve outcomes but increase risk of adverse effects and resistance 1

4. Failure to obtain cultures: Culture confirmation is essential for tailoring therapy based on bacterial sensitivities 1

5. Not considering local resistance patterns: Local antibiograms should guide empiric therapy choices 1

By following these evidence-based recommendations, clinicians can effectively treat uncomplicated UTIs in men while minimizing the risk of treatment failure and antibiotic resistance.