From the Guidelines
For complicated UTIs in males with Enterobacter, the recommended duration of antibiotic therapy is typically 7-14 days, with some cases requiring up to 14 days of treatment, as supported by the most recent guidelines 1. The specific antibiotic choice should be guided by susceptibility testing, but fluoroquinolones (such as ciprofloxacin 500mg twice daily or levofloxacin 750mg once daily), carbapenems (like meropenem 1g every 8 hours), or cefepime (2g every 12 hours) are often effective options against Enterobacter 1. Some key points to consider in the management of complicated UTIs include:
- Treatment should begin with intravenous antibiotics if the infection is severe, with transition to oral therapy when clinical improvement occurs.
- It's essential to complete the full course of antibiotics even if symptoms resolve earlier to prevent recurrence and development of resistance.
- Enterobacter species frequently possess inducible beta-lactamases that can develop resistance during therapy, so monitoring clinical response is crucial 1.
- Urologic evaluation may be necessary to identify and address any underlying anatomical abnormalities or obstructions that could complicate treatment or lead to recurrent infections, as outlined in the European Association of Urology guidelines 1. The duration of treatment should be closely related to the treatment of the underlying abnormality, and when the patient is haemodynamically stable and has been afebrile for at least 48 h, a shorter treatment duration (e.g., 7 d) may be considered in cases for which short-course treatment is desirable owing to relative contraindications to the antibiotic administered 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Duration of Antibiotic Therapy for Complicated UTI in Males
- The duration of antibiotic therapy for complicated UTI in males is not strictly defined, but several studies provide guidance on treatment duration based on the causative organism and clinical situation 2, 3, 4, 5.
- For complicated UTIs caused by Enterobacter, which is an Enterobacterales, the treatment duration may vary, but some studies suggest that short courses of antimicrobial treatment (≤ 7 days) may be effective 4.
- A study on the treatment duration of complicated urinary tract infections by extended-spectrum beta-lactamases producing Enterobacterales found that short courses of antimicrobial treatment (mean duration of 6.1 days) were as effective as long courses (mean duration of 13.8 days) in terms of 30-day mortality and reinfection rates 4.
- Another study on hospitalized patients with complicated UTIs and associated bacteremia found that 7 days of antibiotics appeared effective when antibiotics with comparable intravenous and oral bioavailability were administered, while 10 days may be needed for all other patients 3.
- Guidelines for the management of male urinary tract infections in primary care suggest that the duration of antibiotic treatment for febrile UTIs has been gradually reduced over the last 20 years, with 10-14 days of fluoroquinolones being the international gold standard, although some guidelines propose shorter courses of fluoroquinolone-sparing treatments 5.
Treatment Options for Complicated UTI in Males
- The treatment options for complicated UTI in males depend on the causative organism and its susceptibility pattern, as well as the patient's clinical situation and local resistance patterns 6, 2.
- For Enterobacter infections, treatment options may include carbapenems, piperacillin-tazobactam, and other broad-spectrum antibiotics, as well as fluoroquinolones and aminoglycosides in some cases 6, 2.
- The choice of antibiotic and treatment duration should be guided by the results of culture and sensitivity testing, as well as the patient's clinical response to treatment 2, 3, 4.