From the Guidelines
Urinary tract infections (UTIs) in males should be treated promptly with antibiotics, with a treatment duration of 7-14 days, depending on the severity of the illness and local resistance patterns 1. When managing UTIs in men, it is essential to consider the potential for underlying complicating factors, such as obstruction, incomplete voiding, or recent history of instrumentation, which can increase the risk of complications and affect treatment outcomes 1. The choice of antibiotic should be guided by local resistance patterns and the results of urine culture and susceptibility testing, with options including trimethoprim-sulfamethoxazole, ciprofloxacin, or nitrofurantoin 1. Key considerations in the management of UTIs in men include:
- Identifying and managing any underlying urological abnormalities or complicating factors 1
- Selecting an appropriate antibiotic regimen based on local resistance patterns and susceptibility testing 1
- Monitoring for signs of complications, such as fever, back pain, or blood in the urine, which may require further evaluation and treatment 1
- Considering the potential for prostate issues in men over 50, which can increase the risk of UTIs and affect treatment outcomes 1. In terms of specific treatment recommendations, the European Association of Urology guidelines suggest using a combination of antibiotics, such as amoxicillin plus an aminoglycoside, or a second-generation cephalosporin plus an aminoglycoside, as empirical treatment for complicated UTIs 1. The use of ciprofloxacin should be limited to cases where the local resistance rate is <10%, and the patient does not require hospitalization or has anaphylaxis to beta-lactam antimicrobials 1.
From the Research
Male UTI Overview
- Male urinary tract infections (UTIs) are relatively rare in general practice, accounting for 0.097% of visits and 1.44 visits per physician per year 2.
- The most common types of UTIs in men are undifferentiated (52%), prostatitis (36%), cystitis (8.5%), and pyelonephritis (3.5%) 2.
Causes and Symptoms
- Escherichia coli is the most frequently isolated uropathogen in male UTIs, followed by other enterobacteriaceae and enterococci 3.
- Fever is recorded in 14% of consultations for male UTIs 2.
- Urine dipstick test is done in 1.8% of consultations, and urine culture is positive for Escherichia coli in 50.4% of bacteriological tests 2.
Treatment
- Fluoroquinolones are the most prescribed antibiotics for male UTIs (64.9%), followed by beta-lactams (17.4%), trimethoprim-sulfamethoxazole (11.9%), and nitrofurantoin (2.6%) 2.
- The duration of antibiotic treatment for febrile male UTIs has been gradually reduced over the last 20 years from 28 days to 10-14 days of fluoroquinolones 4.
- Trimethoprim-sulfamethoxazole is an effective agent for both the treatment and prevention of urinary infections, with a high cure rate and low risk of side effects 5, 6.