Treatment of Male Urinary Tract Infections

Classification and Diagnostic Considerations

The European Association of Urology classifies all UTIs in males as complicated UTIs, and urine culture and susceptibility testing should always be performed before initiating therapy to guide appropriate antibiotic selection 1, 2
The microbial spectrum in male UTIs is broader than in uncomplicated UTIs, with common pathogens including E. coli, Proteus spp., Klebsiella spp., Pseudomonas spp., Serratia spp., and Enterococcus spp. 1, 2
Antimicrobial resistance is more likely in male UTIs compared to uncomplicated UTIs 1

The European Urology guidelines recommend first-line options for systemic symptoms, including Amoxicillin plus an aminoglycoside, a second-generation cephalosporin plus an aminoglycoside, and an intravenous third-generation cephalosporin 1
For oral therapy, fluoroquinolones may be used if local resistance rates are <10% 1
Do not use fluoroquinolones for empirical treatment if the patient has used them in the last 6 months 1

The European Urology guidelines recommend treatment for 14 days for men when prostatitis cannot be excluded 1, 2
A 7-day course may be considered when the patient is hemodynamically stable and has been afebrile for at least 48 hours 1
Recent evidence suggests that shorter treatment duration (7 days) may be non-inferior to longer courses (14 days) in men without complicating conditions 3, 4

For catheter-associated UTIs, remove or change the catheter when possible 1, 2
For UTIs with systemic symptoms, consider initial parenteral therapy until clinical improvement 1, 2
In patients with structural abnormalities, management of the underlying urological abnormality is mandatory alongside antibiotic therapy 1

Tailor therapy based on culture results once available 1
Consider imaging studies if recurrent infections occur to rule out anatomical abnormalities 5

Failing to obtain urine culture before starting antibiotics 1
Using fluoroquinolones empirically in areas with high resistance rates (>10%) 1
Not considering prostatitis as a complication of UTI in men, which requires longer treatment 1, 2
Treating all male UTIs with prolonged courses when shorter durations may be appropriate for certain patients 3, 4
Not addressing underlying anatomical or functional abnormalities that may contribute to infection 1

A 7-day course of treatment with either fluoroquinolones or trimethoprim/sulfamethoxazole was found to be non-inferior to 14-day treatment in men with UTI, according to a study by Drekonja et al. 6