From the Guidelines
For men with a history of vesicoureteral reflux (VUR) who develop a urinary tract infection (UTI), the recommended antibiotic treatment should be guided by the results of urine culture and sensitivity testing, with consideration of local resistance patterns and the severity of the illness, as outlined in the 2024 European Association of Urology guidelines 1.
Key Considerations
- The microbial spectrum in complicated UTIs, such as those in men with VUR, is broader and includes organisms like E. coli, Proteus spp., Klebsiella spp., Pseudomonas spp., Serratia spp., and Enterococcus spp. 1.
- Antimicrobial resistance is more likely in complicated UTIs, making the choice of antibiotic critical 1.
- The duration of treatment should be tailored to the individual case but generally ranges from 7 to 14 days, with longer durations considered for men with potential prostatitis or more severe infections 1.
Treatment Options
- Fluoroquinolones, such as ciprofloxacin 500mg twice daily or levofloxacin 750mg once daily, can be considered for 7-14 days, but their use should be guided by local resistance rates and patient-specific factors, as recommended by the European Association of Urology guidelines 1.
- Alternative options may include trimethoprim-sulfamethoxazole (TMP-SMX) or other agents based on culture and sensitivity results.
- It is crucial to manage any underlying urological abnormality or complicating factors, as emphasized in the guidelines 1.
Additional Measures
- Urine culture and sensitivity testing should always be performed to guide antibiotic therapy.
- For recurrent UTIs, prophylactic antibiotics might be considered, along with increased fluid intake, prompt urination, and regular urological evaluation to assess the status of the reflux.
- The choice of antibiotic should be made cautiously, considering the potential for resistance and the specific pathogens involved, as well as the patient's medical history and current health status 1.
From the Research
Antibiotic Recommendations for UTIs in Men with VUR
There are no specific studies provided that directly address the recommended antibiotics for urinary tract infections (UTIs) in men with a history of vesicoureteral reflux (VUR). However, based on the available evidence, the following information can be gathered:
- For acute uncomplicated bacterial cystitis, first-line empiric antibiotic therapy includes nitrofurantoin, fosfomycin tromethamine, or pivmecillinam 2.
- Second-line options include oral cephalosporins, fluoroquinolones, and β-lactams such as amoxicillin-clavulanate 2.
- For UTIs caused by extended-spectrum β-lactamases (ESBLs)-producing Enterobacteriales, treatment options include nitrofurantoin, fosfomycin, pivmecillinam, amoxicillin-clavulanate, finafloxacin, and sitafloxacin 2.
- Parenteral treatment options for UTIs due to ESBLs-producing Enterobacteriales include piperacillin-tazobactam, carbapenems, ceftazidime-avibactam, and aminoglycosides including plazomicin 2.
Considerations for VUR
Studies have shown that endoscopic injection is an effective treatment for VUR in adults 3, and that antibiotic prophylaxis may not be necessary for low-grade VUR 4. However, the management of VUR and UTIs should be individualized based on the patient's specific condition and medical history.
Treatment Protocols for UTIs
Implementation of a UTI treatment protocol can improve prescribing practices and reduce the use of inappropriate antimicrobials 5. The protocol should emphasize correct UTI diagnosis and use of empiric therapy based on the institutional antibiogram.
Some key points to consider when treating UTIs in men with VUR include:
- The choice of antibiotic should be based on the severity of the infection, the patient's medical history, and local susceptibility patterns.
- First-line empiric antibiotic therapy may include nitrofurantoin, fosfomycin tromethamine, or pivmecillinam.
- Second-line options and parenteral treatment options should be considered based on the specific circumstances of the patient.