What is the recommended treatment for pseudomonas (Pseudomonas aeruginosa) urinary tract infection (UTI) in men?

Treatment of Pseudomonas UTI in Men

For men with Pseudomonas aeruginosa urinary tract infections, a 7-day course of fluoroquinolones such as ciprofloxacin or levofloxacin is recommended as first-line therapy, guided by antimicrobial susceptibility testing. 1, 2

Diagnostic Approach

• Obtain urine culture and antimicrobial susceptibility testing before initiating treatment
• Male UTIs are classified as complicated UTIs according to European Association of Urology guidelines 2
• Pseudomonas aeruginosa requires targeted therapy based on susceptibility patterns

Treatment Algorithm

First-line Treatment

• Fluoroquinolones (if local resistance rates <10%):
  • Ciprofloxacin 500-750mg twice daily for 7 days
  • Levofloxacin 750mg once daily for 7 days 2, 3

Alternative Options (based on susceptibility testing)

• For susceptible Pseudomonas strains:
  • Trimethoprim-sulfamethoxazole 160/800mg twice daily for 7 days 1
  • Piperacillin-tazobactam (for severe infections requiring parenteral therapy) 4
  • Ceftazidime or cefepime (parenteral options) 4

For Resistant Pseudomonas

• MDR-Pseudomonas options:
  • Ceftolozane-tazobactam
  • Ceftazidime-avibactam
  • Meropenem (if susceptible)
  • Fosfomycin (if susceptible) 4

Important Considerations

Duration of Treatment

• Male UTIs require longer treatment (7 days minimum) than uncomplicated UTIs in women 2
• Some evidence suggests 5-day courses of high-dose levofloxacin (750mg daily) may be effective in males with UTIs 5
• For severe infections or those with systemic symptoms, consider extending treatment to 10-14 days 2

Catheter Management

• If a urinary catheter is present, it should be removed or changed when possible
• Patients with indwelling catheters have higher rates of febrile UTIs (66.7% vs 40.5% in non-catheterized patients) 6

Monitoring and Follow-up

• Obtain surveillance urine culture 1 week after completing therapy to ensure resolution 2
• If cultures remain positive, consider longer course of therapy or catheter exchange if applicable

Special Considerations

• Pseudomonas aeruginosa can develop resistance rapidly during treatment with fluoroquinolones 3
• Culture and susceptibility testing should be performed periodically during therapy to monitor for emerging resistance 3
• For severe infections with systemic symptoms (fever >38°C, chills), consider initial parenteral therapy until symptoms subside 1

Pitfalls to Avoid

• Using empiric therapy without obtaining cultures first
• Treating for too short a duration (male UTIs require longer treatment than female UTIs)
• Failing to follow up with surveillance cultures
• Ignoring local resistance patterns when selecting empiric therapy
• Not removing or changing indwelling catheters when possible

By following this treatment approach, clinicians can effectively manage Pseudomonas UTIs in male patients while minimizing the risk of treatment failure and antimicrobial resistance.