Treatment of Urinary Tract Infections in Men
Male patients with urinary tract infections should be treated with a 14-day course of antibiotics when prostatitis cannot be excluded, though a 7-day course may be sufficient for uncomplicated cases with prompt symptom resolution. 1
Diagnosis Considerations
Before initiating treatment, proper evaluation is essential:
- Obtain a urine culture before starting antibiotics
- Perform a Gram-stained smear of urethral exudate or intraurethral swab for diagnosis of urethritis
- Examine first-void urine for leukocytes if urethral Gram stain is negative
- Consider syphilis serology and HIV testing 2
Treatment Approach
For UTIs Most Likely Caused by Gonococcal or Chlamydial Infection:
- Ceftriaxone 250 mg IM in a single dose, PLUS
- Doxycycline 100 mg orally twice a day for 10 days 2
For UTIs Most Likely Caused by Enteric Organisms:
- Trimethoprim-sulfamethoxazole (160/800mg twice daily) for 7-14 days 1, 3
- Fluoroquinolones (ciprofloxacin 500-750mg twice daily or levofloxacin 750mg once daily) for 7 days 1
- Ofloxacin 300 mg orally twice a day for 10 days (for patients allergic to cephalosporins/tetracyclines) 2
Duration of Therapy:
- 7-14 days for complicated UTI 1
- 7 days may be sufficient for uncomplicated cases with prompt symptom resolution 4
Special Considerations
Prostatitis
- Male UTIs often involve the prostate gland
- Chronic bacterial prostatitis requires prolonged antibiotic therapy (6-12 weeks) 5
- Use antibiotics that penetrate prostatic tissue:
- Trimethoprim-sulfamethoxazole
- Fluoroquinolones (preferred) 5
Antimicrobial Resistance
- Consider local resistance patterns when selecting empiric therapy
- Avoid fluoroquinolones as first-line therapy due to serious adverse effects (tendon damage, peripheral neuropathy, CNS effects) 1
- For multidrug-resistant organisms, treatment options include:
- Nitrofurantoin
- Fosfomycin
- Carbapenems (for severe infections) 6
Renal Impairment
Adjust dosing for patients with impaired renal function:
- For trimethoprim-sulfamethoxazole:
- CrCl >30 mL/min: Standard regimen
- CrCl 15-30 mL/min: Half the usual regimen
- CrCl <15 mL/min: Not recommended 3
Adjunctive Measures
- Bed rest
- Scrotal elevation (if epididymitis is present)
- Analgesics until fever and local inflammation subside 2
Follow-Up
- Failure to improve within 3 days requires reevaluation of diagnosis and therapy
- Persistent swelling and tenderness after completing antimicrobial therapy should be comprehensively evaluated 2
- Consider partner treatment if sexually transmitted infection is suspected
Common Pitfalls to Avoid
- Treating male UTIs with short courses (3-5 days) as would be done for uncomplicated UTIs in women
- Failing to consider prostatitis in men with UTI symptoms
- Not obtaining urine culture before starting antibiotics
- Using antibiotics that don't adequately penetrate prostatic tissue
- Overlooking potential anatomical abnormalities or functional conditions that may complicate UTIs in men
Remember that UTIs in men are generally considered complicated infections and require longer treatment courses than those typically used for women with uncomplicated UTIs.