Management of Urinary Tract Infections in Males

Diagnostic Approach

The European Urology guidelines recommend obtaining urine culture and susceptibility testing before initiating antimicrobial therapy to guide targeted treatment 2
Urinalysis, including assessment of white and red blood cells and nitrite, is recommended for routine diagnosis, as suggested by the European Urology guidelines 3
Male urinary tract infections should be considered complicated infections, requiring special consideration due to the broader microbial spectrum and higher likelihood of antimicrobial resistance, according to the European Urology guidelines 2

The European Urology guidelines recommend trimethoprim-sulfamethoxazole 160/800 mg twice daily for 7 days as the first-line treatment for urinary tract infections in males 1
Ciprofloxacin 500 mg twice daily for 7 days is an alternative option, but only if local fluoroquinolone resistance is <10% and the patient has no history of fluoroquinolone use in the past 6 months, as suggested by the European Urology guidelines 3

The European Urology guidelines consider male gender itself a complicating factor for urinary tract infections, requiring longer treatment courses (7 days minimum) 2
Nitrofurantoin should be avoided for male urinary tract infections, as there are insufficient data regarding its efficacy in complicated infections, according to the European Urology guidelines 3

The European Urology guidelines recommend reassessing after 48-72 hours of empiric therapy to evaluate clinical response, and adjusting therapy based on culture and susceptibility results 2
For patients whose symptoms do not resolve by the end of treatment, or recur within 2 weeks, the European Urology guidelines suggest performing a urine culture and antimicrobial susceptibility testing 1

The European Urology guidelines advise against using shorter treatment courses (<7 days) in males, as this can lead to treatment failure, and against using single-dose or 3-day regimens that might be appropriate for uncomplicated cystitis in women, as these are inadequate for male urinary tract infections 1, 2