What are the usual antibiotics, doses, and frequencies for treating urinary tract infections (UTI) in men?

Antibiotic Treatment for UTI in Men

For men with urinary tract infections, trimethoprim-sulfamethoxazole 160/800 mg twice daily for 7 days is the first-line treatment, with fluoroquinolones (ciprofloxacin or levofloxacin) reserved as alternatives based on local susceptibility patterns. 1

First-Line Antibiotic Regimen

Trimethoprim-sulfamethoxazole (TMP-SMX):

• Dose: 160/800 mg (one double-strength tablet) twice daily 1, 2
• Duration: 7 days for uncomplicated UTI 1
• Duration: 14 days when prostatitis cannot be excluded (which is often the case in initial presentations) 3

This is the guideline-recommended first-line agent specifically for men, as UTIs in males are considered complicated infections due to anatomical factors requiring longer treatment than the 3-day courses used in women. 3

Alternative Antibiotic Options

Fluoroquinolones (when TMP-SMX cannot be used or resistance suspected):

• Ciprofloxacin: 500 mg twice daily for 7-14 days 3, 4

  • Use 7 days if patient becomes afebrile within 48 hours with clear clinical improvement 3
  • Extend to 14 days when prostatitis cannot be excluded 3

• Levofloxacin: 750 mg once daily for 7-14 days 3

  • Same duration considerations as ciprofloxacin 3

Oral Cephalosporins (alternative when TMP-SMX resistance or allergy):

• Cefpodoxime: 200 mg twice daily for 10 days 3
• Ceftibuten: 400 mg once daily for 10 days 3

Critical Clinical Considerations

Obtain urine culture before initiating antibiotics to guide potential adjustments based on susceptibility results, as the microbial spectrum in male UTIs is broader than in uncomplicated female UTIs with increased likelihood of antimicrobial resistance. 3

Common uropathogens in men include:

• E. coli (most common)
• Proteus species
• Klebsiella species
• Pseudomonas species
• Enterococcus species 3

Duration decision-making:

• 7 days: Acceptable if patient becomes afebrile within 48 hours and shows clear clinical improvement 3
• 14 days: Required when prostatitis cannot be excluded, which is frequently the case in initial presentations 3

Common Pitfalls to Avoid

Do not use fluoroquinolones as first-line empiric therapy when other effective options like TMP-SMX are available, due to increasing resistance rates and the need to preserve these agents for more resistant infections. 3, 5

Do not treat for only 3-5 days as recommended for women—men require minimum 7 days due to the complicated nature of male UTIs and potential prostatic involvement. 1, 3

Do not skip urine culture in men, as this can complicate management if initial empiric therapy fails and you lack susceptibility data. 3

Consider underlying urological abnormalities that may contribute to infection or recurrence, particularly in men with recurrent UTIs or those who fail initial therapy. 3

Special Populations

Renal impairment dosing for TMP-SMX:

• Creatinine clearance 30-50 mL/min: 250-500 mg every 12 hours 2
• Creatinine clearance 5-29 mL/min: 250-500 mg every 18 hours 2
• Hemodialysis: 250-500 mg every 24 hours (after dialysis) 2

Renal impairment dosing for ciprofloxacin:

• Creatinine clearance 30-50 mL/min: 250-500 mg every 12 hours 4
• Creatinine clearance 5-29 mL/min: 250-500 mg every 18 hours 4