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

From the Guidelines

For inpatient treatment of urinary tract infections (UTIs) in males, empiric therapy should begin with intravenous antibiotics while awaiting culture results, with a treatment duration of 7-14 days, depending on the severity of the illness and underlying complicating factors 1. When managing male inpatients with UTIs, it is crucial to consider the potential for complicated infections, especially given the higher likelihood of antimicrobial resistance and a broader microbial spectrum compared to uncomplicated UTIs 1.

• Key factors to consider in the management of UTIs in male inpatients include:
  • The presence of obstruction at any site in the urinary tract
  • Recent history of instrumentation
  • Infection with ESBL-producing organisms or multidrug-resistant organisms
  • Underlying health conditions such as diabetes mellitus or immunosuppression
• Initial empiric therapy may include intravenous antibiotics such as ceftriaxone, ciprofloxacin, or piperacillin-tazobactam, with consideration of carbapenems for patients at risk of multidrug-resistant organisms 1.
• Treatment should be tailored based on urine culture and susceptibility testing, with adjustment of antibiotics as necessary to ensure appropriate coverage for the isolated uropathogen 1.
• The duration of treatment should be closely related to the treatment of the underlying abnormality, with a general recommendation of 7-14 days, and up to 14 days for men when prostatitis cannot be excluded 1.
• Ensuring adequate hydration, pain management, and consideration of urologic evaluation for structural abnormalities are also important aspects of managing UTIs in male inpatients.

From the FDA Drug Label

CLINICAL STUDIES Complicated Urinary Tract Infection and Pyelonephritis Ciprofloxacin, administered I. V. and/or orally, was compared to a cephalosporin for treatment of complicated urinary tract infections (cUTI) and pyelonephritis

The treatment for urinary tract infection (UTI) in male inpatients is not directly addressed in the provided drug label.

• The label discusses the use of ciprofloxacin in febrile neutropenic patients and in pediatric patients with complicated urinary tract infections (cUTI) and pyelonephritis.
• There is no information provided about the treatment of UTI in adult male inpatients. 2

From the Research

Treatment for Urinary Tract Infection (UTI) in Male Inpatients

• The treatment for UTI in male inpatients is not well-established, with limited research available 3.
• A systematic review of randomized controlled trials (RCTs) comparing the effectiveness of different antimicrobial treatments and durations for uncomplicated UTIs in adult males found that the evidence available is insufficient to make any recommendations in relation to type and duration of antimicrobial treatment for male UTIs 3.
• However, a post hoc, subgroup analysis of male and female subjects with complicated UTI found that males with UTI may be treated with a shorter course of antimicrobial therapy for UTI than previously recommended 4.
• Fluoroquinolones, such as levofloxacin, have been shown to be effective in treating UTIs in males, with a 5-day course being sufficient in some cases 4, 5.
• The use of fluoroquinolones for empiric treatment of UTIs should be restricted due to increased rates of resistance, and alternatives such as nitrofurantoin, fosfomycin, and cefepime may be considered 6.
• A retrospective chart review of adult patients in an internal medicine clinic diagnosed with UTI found that the prescribing habits did not always align with Infectious Diseases Society of America (IDSA) guidelines for antibiotic selection and duration of therapy 7.
• The choice of antibiotic and duration of treatment should be based on the severity and location of the UTI, as well as the patient's renal function and local susceptibility patterns 6, 7.
• Antibiotic switch rates after treatment with UTI antibiotics in men have been found to be relatively low, indicating that the current guidelines are safe, but fluoroquinolones and cefalexin were associated with lower antibiotic switch rates than the recommended UTI antibiotics 5.