From the Guidelines
The initial workup for a male with a urinary tract infection (UTI) should include a thorough history, physical examination, urinalysis, and urine culture before starting empiric antibiotic therapy. Males with UTIs require more extensive evaluation than females due to the lower incidence and higher likelihood of underlying abnormalities, as emphasized by the European Association of Urology guidelines on urological infections 1. The history should focus on urinary symptoms (dysuria, frequency, urgency, hematuria), risk factors, and previous episodes. Physical examination should include vital signs, abdominal examination, digital rectal examination to assess the prostate, and examination of external genitalia.
Some key points to consider in the initial workup include:
- Laboratory tests should include urinalysis with microscopy (looking for pyuria, bacteriuria, hematuria) and urine culture with sensitivity testing, as recommended by the guidelines 1.
- For uncomplicated UTIs in men, empiric antibiotic therapy typically includes trimethoprim-sulfamethoxazole (160/800 mg twice daily for 7-14 days), fluoroquinolones like ciprofloxacin (500 mg twice daily for 7 days), or nitrofurantoin (100 mg four times daily for 7 days).
- Men with complicated UTIs, recurrent infections, or signs of pyelonephritis may require imaging studies such as ultrasound or CT to evaluate for structural abnormalities, and possibly urologic consultation, as outlined in the guidelines 1.
- The longer treatment duration compared to women is necessary because of the higher likelihood of prostatic involvement in male UTIs, which requires adequate antibiotic penetration into prostatic tissue.
It is essential to note that the European Association of Urology guidelines on urological infections provide evidence-based recommendations for the diagnosis, treatment, and prevention of UTIs and male accessory-gland infections, and should be consulted for further guidance 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Initial Workup for Male UTI
The initial workup for a male with a urinary tract infection (UTI) involves several steps to diagnose and manage the condition effectively. According to the study 2, the initial evaluation should include:
- Identification of cardiovascular risk factors, metabolic syndrome, current medication, urinary and sexual symptoms (by structured interview or validated self-questionnaires)
- Physical examination (lumbar fossa, pelvis, prostate, genitalia)
- Urinalysis (dipstick or microscopy)
- Abdominal ultrasound of the urinary tract (kidneys, bladder, prostate)
- Post-void residual urine measurement (by ultrasound or automated measurement; under physiological conditions)
- Micturition flowmetry is recommended (except for general practitioners)
Referral to Urologist
The study 2 also recommends referring the patient to a urologist in case of:
- Macroscopic hematuria
- Recurrent urinary tract infection or persistent perineal and/or suprapubic pain
- Persistent microscopic hematuria or leukocyturia in absence of urinary tract infection
- Predominant storage-phase symptoms
- Abnormal examination of the genitals or suspected prostate cancer
- Urinary retention
- Urinary tract stones
- Ureterohydronephrosis or morphological abnormalities of the prostate or the urinary tract
Antibiotic Resistance
The studies 3, 4, and 5 highlight the importance of considering antibiotic resistance when treating UTIs. The resistance patterns of common uropathogens, such as Escherichia coli, should be taken into account when selecting empirical antibiotic therapy. The use of a prior culture to guide empirical prescribing can enhance the probability of selecting an effective agent 5.