What antibiotic is recommended for a male Urinary Tract Infection (UTI)?

From the Guidelines

For a male urinary tract infection (UTI), the most effective treatment is a 7-14 day course of antibiotics, with fluoroquinolones or trimethoprim-sulfamethoxazole being suitable options, as recommended by the European Association of Urology guidelines 1. When considering the treatment of male UTIs, it's essential to note that these infections are often complicated by anatomical factors and may involve the prostate. The choice of antibiotic and duration of treatment should be guided by the severity of the illness, local resistance patterns, and specific host factors, such as allergies.

• Key considerations in treating male UTIs include:
  • Completing the full course of antibiotics, even if symptoms improve before finishing
  • Increasing fluid intake and urinating frequently to help clear the infection
  • Seeking prompt medical attention, as male UTIs can indicate underlying issues like prostate problems or anatomical abnormalities
  • Obtaining a urine culture to identify the specific bacteria causing the infection and ensure the selected antibiotic will be effective against it According to the most recent guidelines, a urine culture and susceptibility testing should be performed, and initial empiric therapy should be tailored and followed by the administration of an appropriate antimicrobial agent for the uropathogen isolated 1.
• The European Association of Urology guidelines recommend treatment for 7-14 days, with the duration closely related to the treatment of the underlying abnormality 1.
• A study published in Clinical Microbiology and Infection found that short-duration therapy (5-7 days) can be as effective as long-duration therapy (10-14 days) for complicated UTIs, including in men 1. It's crucial to prioritize the patient's morbidity, mortality, and quality of life when making treatment decisions, and to choose the most effective antibiotic regimen based on the latest evidence and guidelines.
• The American College of Physicians recommends short-course antibiotics for uncomplicated UTIs, but notes that men with UTIs may require longer treatment durations due to the potential for complications 1.

From the FDA Drug Label

1. 8 Chronic Bacterial Prostatitis Levofloxacin tablets are indicated for the treatment of chronic bacterial prostatitis due to Escherichia coli, Enterococcus faecalis, or methicillin-susceptible Staphylococcus epidermidis [see Clinical Studies (14.6)].

Levofloxacin is indicated for the treatment of chronic bacterial prostatitis due to Escherichia coli, Enterococcus faecalis, or methicillin-susceptible Staphylococcus epidermidis.

• Key points:
  • Indication: Chronic bacterial prostatitis
  • Pathogens: Escherichia coli, Enterococcus faecalis, methicillin-susceptible Staphylococcus epidermidis
  • Reference: 2

From the Research

Antibiotic Treatment for Male UTI

• The treatment of urinary tract infections (UTIs) in men is not as well-defined as in women, and there is a need for new guidelines 3.
• According to a study, fluoroquinolones were the most prescribed antibiotics for male UTIs, followed by beta-lactams, trimethoprim-sulfamethoxazole, and nitrofurantoin 3.
• However, the use of trimethoprim-sulfamethoxazole as a first-line empiric therapy for UTIs is not recommended in institutions with resistance rates exceeding 20% for Escherichia coli (E. coli) 4.
• Risk factors for trimethoprim-sulfamethoxazole-resistant E. coli in ED patients with UTIs include recurrent UTI, genitourinary abnormalities, and previous use of trimethoprim-sulfamethoxazole within 90 days 4.
• Alternative empiric antibiotic therapies for UTIs include nitrofurantoin, fosfomycin, and pivmecillinam, which have been shown to be effective against E. coli and other common uropathogens 5, 6.
• The choice of antibiotic should be guided by local susceptibility patterns and the patient's medical history, including any previous antibiotic use or underlying medical conditions 5, 4.

Common Uropathogens and Antibiotic Resistance

• E. coli is the most common cause of UTIs in men, accounting for approximately 50% of cases 3.
• Other common uropathogens include Klebsiella pneumoniae, Pseudomonas aeruginosa, and Enterobacteriaceae 5.
• Antibiotic resistance rates vary by institution and region, but trimethoprim-sulfamethoxazole resistance rates exceeding 20% have been reported in some areas 4.
• Fosfomycin has been shown to be effective against E. coli and other common uropathogens, with low resistance rates 6.

Treatment Options for Complicated UTIs

• For complicated UTIs, including those caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, treatment options include parenteral antibiotics such as piperacillin-tazobactam, carbapenems, and ceftazidime-avibactam 5.
• Oral treatment options for UTIs due to ESBL-producing E. coli include nitrofurantoin, fosfomycin, and pivmecillinam 5.
• Treatment options for UTIs caused by carbapenem-resistant Enterobacteriaceae (CRE) include ceftazidime-avibactam, meropenem/vaborbactam, and imipenem/cilastatin-relebactam 5.