What antibiotic is recommended for complicated Urinary Tract Infection (UTI) in men?

From the Guidelines

For complicated urinary tract infections (UTIs) in men, a combination of amoxicillin plus an aminoglycoside or a second-generation cephalosporin plus an aminoglycoside is recommended as empirical treatment, with consideration of local resistance patterns and patient-specific factors 1. The choice of antibiotic should be guided by the severity of the illness, local resistance patterns, and specific host factors such as allergies.

• A urine culture and susceptibility testing should be performed to tailor the initial empiric therapy.
• The treatment duration for complicated UTIs in men is typically 7-14 days, but may be shorter or longer depending on the underlying abnormality and clinical response.
• Addressing any underlying anatomical or functional abnormalities is crucial for effective treatment.
• Broader-spectrum antibiotics such as ceftriaxone or piperacillin-tazobactam may be necessary for more severe infections or those involving resistant organisms 1.
• It is essential to note that ciprofloxacin and other fluoroquinolones should only be used if the local resistance rate is <10% and the patient does not require hospitalization, and not as empirical treatment in patients from urology departments or those who have used fluoroquinolones in the last 6 months 1.
• Recent studies suggest that short-duration courses of antibiotics may be effective for complicated UTIs, but more data are needed to confirm this in men 1.

From the FDA Drug Label

1. 9 Complicated Urinary Tract Infections: 5 Day Treatment Regimen Levofloxacin tablets are indicated for the treatment of complicated urinary tract infections due to Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis [see Clinical Studies (14.7)].
2. 10 Complicated Urinary Tract Infections: 10 Day Treatment Regimen Levofloxacin tablets are indicated for the treatment of complicated urinary tract infections (mild to moderate) due to Enterococcus faecalis, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Pseudomonas aeruginosa [see Clinical Studies (14.8)].

Levofloxacin is indicated for the treatment of complicated urinary tract infections due to various pathogens, including Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis, Enterobacter cloacae, and Pseudomonas aeruginosa.

• The treatment regimen can be either 5 days or 10 days, depending on the severity of the infection and the causative pathogen.
• The dosage and administration of levofloxacin for complicated urinary tract infections are described in the clinical studies sections of the label 2, 2, and 2.

From the Research

Antibiotic Treatment for Complicated UTI in Men

• The treatment of complicated urinary tract infections (UTIs) in men typically involves the use of antibiotics, with fluoroquinolones being a common choice 3, 4, 5, 6, 7.
• A study published in 2016 found that a 5-day course of levofloxacin was noninferior to a 10-day course of ciprofloxacin for the treatment of complicated UTIs in men 3.
• Another study published in 2024 found that only half of male patients with complicated UTIs received recommended first-choice therapy, which includes the use of a recommended first-line antibiotic and a recommended duration of 7 to 10 days of therapy 4.
• A 2008 study compared the efficacy and safety of levofloxacin 750 mg once daily for 5 days to ciprofloxacin twice daily for 10 days for the treatment of complicated UTIs and acute pyelonephritis, and found that both regimens were safe and effective 5.
• Ciprofloxacin extended release has also been shown to be effective in the treatment of UTIs, with a once-daily formulation that achieves a higher maximum serum concentration than twice-daily ciprofloxacin 6.
• A 2021 systematic review and meta-analysis found that levofloxacin and ciprofloxacin had similar efficacy and safety profiles for the treatment of UTIs, but suggested that levofloxacin may be superior to ciprofloxacin for the treatment of E. coli-induced chronic bacterial prostatitis 7.

Recommended Antibiotics

• Levofloxacin and ciprofloxacin are both recommended for the treatment of complicated UTIs in men 3, 4, 5, 6, 7.
• Sulfamethoxazole/trimethoprim is also a recommended first-line antibiotic for uncomplicated UTIs, but its use may be limited by resistance patterns 6.
• Nitrofurantoin is another option for the treatment of UTIs, but its use may be limited by its lower efficacy against certain pathogens 4.

Treatment Duration

• The recommended duration of treatment for complicated UTIs in men is typically 7 to 10 days 4.
• However, a 5-day course of levofloxacin has been shown to be noninferior to a 10-day course of ciprofloxacin for the treatment of complicated UTIs in men 3.
• The treatment duration may vary depending on the severity of the infection, the presence of underlying medical conditions, and the response to treatment.