What is the treatment for a male urinary tract infection (UTI)?

Treatment of Male Urinary Tract Infections

Male urinary tract infections (UTIs) should be treated as complicated UTIs with trimethoprim-sulfamethoxazole 160/800 mg twice daily for 7-14 days, or with fluoroquinolones if local resistance patterns permit. 1

First-Line Treatment Options

• Trimethoprim-sulfamethoxazole (TMP-SMX):

  • Dosage: 160/800 mg twice daily
  • Duration: 7-14 days (extend to 14 days when prostatitis cannot be excluded)
  • Particularly effective when local resistance rates are low 1, 2

• Fluoroquinolones (alternative when local resistance to TMP-SMX is high):

  • Options include ciprofloxacin or levofloxacin
  • Should only be used when local resistance is less than 10%
  • Preferred for prostatitis due to excellent prostate penetration 1, 3

Diagnostic Approach

1. Obtain urine culture before starting antibiotics

   • Essential to confirm causative pathogen and guide therapy
   • Common pathogens: E. coli, Proteus species, Klebsiella species, Pseudomonas species, and Enterococcus species 1

2. Consider local resistance patterns when selecting empiric therapy

   • Adjust therapy based on culture results and susceptibility testing

3. Evaluate for underlying abnormalities

   • Male UTIs typically involve structural or functional abnormalities
   • Consider urological evaluation, especially in recurrent cases 1

Treatment Duration

• Standard duration: 7-14 days 1
• Extended treatment (14 days): When prostatitis cannot be excluded
• Shorter duration (7 days): Only when patient has been afebrile for at least 48 hours and is hemodynamically stable
• Follow-up: Consider repeat urine culture after treatment completion to confirm eradication 1

Special Considerations

1. Avoid short-course therapy

   • Male UTIs require longer treatment durations than uncomplicated UTIs in women 1

2. Don't overlook prostatitis

   • Prostate involvement is common in male UTIs
   • Requires extended treatment duration (14 days) 1

3. Severe infections

   • Initial IV therapy may be necessary with:
     • Fluoroquinolones
     • Extended-spectrum cephalosporins
     • Aminoglycosides
     • Piperacillin-tazobactam 1

Common Pitfalls to Avoid

1. Using inadequate treatment duration

   • Male UTIs require longer treatment (7-14 days) than uncomplicated UTIs in women 1

2. Failing to adjust therapy based on culture results

   • Initial empiric therapy should be modified once culture and sensitivity results are available 1, 2

3. Not evaluating for underlying structural abnormalities

   • Urological conditions often contribute to male UTIs and may require specific management 1

4. Using fluoroquinolones as first-line when resistance is high

   • Check local resistance patterns before prescribing
   • Reserve fluoroquinolones for more invasive infections when other options are available 1, 4

Male UTIs should be approached differently from uncomplicated UTIs in women, with longer treatment durations and careful consideration of potential prostate involvement. Trimethoprim-sulfamethoxazole remains the first-line agent when local resistance is low, with fluoroquinolones as an alternative when necessary.