What is the treatment for penile infections in men taking Jardiance (Empagliflozin)?

Treatment of Penile Infections in Men Taking Jardiance (Empagliflozin)

For men taking Jardiance (empagliflozin) who develop penile infections, topical antifungal agents are the first-line treatment, as these infections are typically fungal in nature caused by Candida species. 1, 2

Types of Infections Associated with SGLT2 Inhibitors

• Genital mycotic infections (including balanitis) are a known side effect of SGLT2 inhibitors like Jardiance, occurring in 3.7% of patients taking empagliflozin 25 mg compared to 0.9% in placebo 2
• Male patients specifically may develop phimosis, occurring in 0.1% of those taking Jardiance 25 mg 2
• These infections are typically caused by Candida species and are related to increased glycosuria induced by the medication 3

Risk Factors for Developing Genital Infections

• Previous history of genital fungal infections (2.4 times increased risk) 4
• Female sex (though the question specifically asks about men) 4
• Poor glycemic control 3
• Multiple risk factors may increase the risk of progression to more severe infections 5

Treatment Approach for Penile Infections

First-Line Treatment

• Topical antifungal agents are the primary treatment for balanitis in men taking SGLT2 inhibitors 1
• Recommended topical options include:
  • Clotrimazole cream 1
  • Miconazole cream 1
  • Other azole antifungals (e.g., econazole, ketoconazole) 1

For Resistant or Severe Infections

• Oral fluconazole 150 mg as a single dose may be considered for more extensive infections 1
• If fluconazole resistance is suspected, alternative oral azoles such as itraconazole may be effective 6
• For recurrent infections, a longer duration of therapy may be needed 1

For Bacterial Co-infection or Non-responsive Cases

• If bacterial infection is suspected or fungal treatment fails, consider treatment for non-gonococcal urethritis:
  • Azithromycin 1 g orally in a single dose (preferred) 1
  • OR Doxycycline 100 mg orally twice daily for 7 days 1

Management Considerations

• Temporary discontinuation of Jardiance should be considered in cases of severe or recurrent infections 5
• Improved glycemic control may help reduce risk of recurrence 3
• Patients should be advised about proper genital hygiene 1
• For recurrent infections, prophylactic antifungal therapy may be considered 1

Follow-Up Recommendations

• Patients should return for evaluation if symptoms persist after completing therapy 1
• If symptoms persist despite appropriate antifungal therapy, consider:
  • Alternative antifungal agents based on susceptibility testing 6
  • Evaluation for other causes of balanitis 1
  • Possible temporary discontinuation of empagliflozin 5

Warning Signs of Serious Infection

• Patients should be monitored for signs of spreading infection or Fournier's gangrene (necrotizing fasciitis of the perineum) 5
• Warning signs include:
  • Fever
  • Severe pain
  • Extensive erythema or swelling
  • Systemic symptoms
• Fournier's gangrene requires immediate medical attention, surgical debridement, and broad-spectrum antibiotics 5