From the Guidelines
Adolescent males with urinary tract infections (UTIs) should be treated with antibiotics such as trimethoprim-sulfamethoxazole (Bactrim) 160/800 mg twice daily for 7-14 days, or ciprofloxacin 500 mg twice daily for 7 days, and evaluated for underlying causes such as urethral strictures, posterior urethral valves, or vesicoureteral reflux, as recommended by the European Association of Urology guidelines on urological infections 1. The treatment of UTIs in adolescent males is crucial to prevent long-term sequelae such as renal scarring, which can lead to hypertension and chronic renal failure 1. The choice of antibiotic and duration of treatment should be based on the severity of the infection, with more severe infections requiring longer treatment courses or intravenous antibiotics such as ceftriaxone 1-2 g IV daily 1. It is essential to obtain a urine culture before starting antibiotics to ensure appropriate treatment and to evaluate for underlying causes of the UTI, such as anatomical abnormalities or obstruction. Adolescent males with UTIs should increase fluid intake, avoid bladder irritants like caffeine, and complete the full course of antibiotics even if symptoms improve. If recurrent UTIs occur, urological evaluation with imaging studies like ultrasound or voiding cystourethrogram is warranted to rule out underlying anatomical abnormalities. The lower incidence of UTIs in males is due to their longer urethra and the antibacterial properties of prostatic fluid, which makes bacterial colonization more difficult than in females. Key considerations in the treatment of UTIs in adolescent males include:
- Obtaining a urine culture before starting antibiotics
- Evaluating for underlying causes of the UTI, such as anatomical abnormalities or obstruction
- Choosing the appropriate antibiotic and duration of treatment based on the severity of the infection
- Increasing fluid intake and avoiding bladder irritants
- Completing the full course of antibiotics even if symptoms improve
- Considering urological evaluation with imaging studies if recurrent UTIs occur.
From the FDA Drug Label
Ciprofloxacin Tablets USP, 250 mg, 500 mg and 750 mg is indicated for the treatment of infections caused by susceptible strains of the designated microorganisms in the conditions and patient populations listed below. Pediatric patients (1 to 17 years of age): Complicated Urinary Tract Infections and Pyelonephritis due to Escherichia coli
The ciprofloxacin drug label indicates that it is used to treat complicated urinary tract infections in pediatric patients, including adolescent males, caused by Escherichia coli 2.
- However, the label also notes that ciprofloxacin is not a drug of first choice in the pediatric population due to an increased incidence of adverse events.
- For uncomplicated urinary tract infections, cefixime is an option for patients six months of age or older, including adolescent males, caused by Escherichia coli and Proteus mirabilis 3.
From the Research
Adolescent Male UTI
- Urinary tract infections (UTIs) are a common issue in adolescents, and their diagnosis and management can be complex 4.
- The treatment of UTI with oral antibiotics alone is generally effective, even in young children with pyelonephritis, and cefixime has a broad spectrum of activity and is suitable as an empiric agent in most cases 5.
- Cefixime has been shown to be effective in treating uncomplicated UTIs, with good results achieved in several studies, including those comparing it to other antibiotics such as amoxicillin and co-trimoxazole 6.
- For adolescent males with UTIs, the choice of antibiotic may depend on various factors, including the severity of the infection, the presence of any underlying medical conditions, and the likelihood of antibiotic resistance 7, 8.
- A network meta-analysis of randomized trials found that ciprofloxacin and gatifloxacin were among the most effective treatments for UTIs, while amoxicillin-clavulanate was less effective 8.
- It is essential to note that the treatment of UTIs in adolescents should be guided by evidence-based guidelines and should take into account the individual patient's needs and circumstances 4.