What is the recommended dose of trimethoprim (TMP) for an uncomplicated male urinary tract infection (UTI)?

Trimethoprim Dosing for Uncomplicated Male UTI

For uncomplicated male urinary tract infections, trimethoprim should be dosed at 200 mg twice daily for 7-14 days, as male UTIs are considered complicated and require longer treatment durations than the 3-day regimens studied in women. 1

Critical Distinction: Male vs Female UTI Treatment

Male UTIs are NOT considered "uncomplicated" by definition and require extended therapy:

• The standard 3-day trimethoprim regimen (100 mg twice daily for 3 days) recommended for women is inadequate for male patients 2
• Males require 7-14 days of treatment due to the complicated nature of male UTIs 1
• The higher dose of 200 mg twice daily for 5 days is recommended as an alternative regimen 1

Recommended Dosing Regimen

Primary recommendation:

• Trimethoprim 200 mg orally twice daily for 5-7 days (minimum duration for males) 1
• Can extend to 14 days if symptoms persist or in complicated cases 1

Important Caveats and Pitfalls

Resistance considerations:

• Only use trimethoprim empirically if local resistance rates are <20% 2
• If resistance patterns unknown or >20%, consider alternative agents 2

Common prescribing errors to avoid:

• Do NOT use the 3-day regimen studied in women - this is the most critical error and leads to treatment failure 1
• Do NOT assume male UTIs are "uncomplicated" - they require longer courses by definition 1

Alternative Considerations

If trimethoprim cannot be used:

• Trimethoprim-sulfamethoxazole (160/800 mg twice daily for 7-14 days) is an alternative 1, 3
• Fluoroquinolones (ciprofloxacin 500 mg twice daily for 7 days) if local resistance <10% 1
• First-line agents like nitrofurantoin or fosfomycin may also be considered based on local guidelines 1

Renal dose adjustment required:

• For CrCl 15-30 mL/min: reduce to half-dose 1
• For CrCl <15 mL/min: avoid or use alternative agent 1