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Urinary Tract Infection in Males Medication

  • Author: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
 
Updated: Oct 22, 2015
 

Medication Summary

The goals of pharmacotherapy are to eradicate the infection, to reduce morbidity, and to prevent complications.

In April 2007, the CDC updated treatment guidelines for gonococcal infection and associated conditions.[25] Fluoroquinolone antibiotics are no longer recommended to treat gonorrhea in the United States. The recommendation was based on analysis of new data from the CDC's Gonococcal Isolate Surveillance Project (GISP).

The data from GISP showed that the proportion of gonorrhea cases in heterosexual men that were fluoroquinolone-resistant (QRNG) had reached 6.7%, an 11-fold increase from 0.6% in 2001. The data were published in the April 13, 2007, issue of the Morbidity and Mortality Weekly Report. This limits treatment of gonorrhea to drugs in the cephalosporin class (eg, ceftriaxone 125mg IM once as a single dose).

Fluoroquinolones may be an alternative treatment option for disseminated gonococcal infection if antimicrobial susceptibility can be documented. If acute prostatitis or epididymitis is not likely to be caused by gonorrhea, fluoroquinolones may be considered as an option. For more information, see the CDC’s Websites for Antibiotic-Resistant Gonorrhea and CDC Updated recommended treatment regimens for gonococcal infections and associated conditions (April 2007).

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Antibiotics

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Ciprofloxacin (Cipro)

 

Ciprofloxacin is a fluoroquinolone with activity against pseudomonads, streptococci, methicillin-resistant S aureus (MRSA), S epidermidis, and most gram-negative organisms, but it has no activity against anaerobes. This agent inhibits bacterial deoxyribonucleic acid (DNA) synthesis and growth. Ciprofloxacin is indicated for urinary tract infections (UTIs) and chronic bacterial prostatitis.

Levofloxacin (Levaquin)

 

Levofloxacin is a fluoroquinolone with better gram-positive activity but less activity against Pseudomonas aeruginosa than ciprofloxacin. This agent is an active L-isomer of ofloxacin. Ciprofloxacin is indicated for complicated and uncomplicated urinary tract infections. It is also used for the treatment of chronic bacterial prostatitis.

Ofloxacin (Floxin)

 

Ofloxacin is a pyridine carboxylic acid derivative with broad-spectrum bactericidal effect. In adults aged 18 years or older, the dosing regimen is by the oral or intravenous (PO/IV) route 200-400mg twice daily (bid). Ofloxacin is FDA approved for the treatment of prostatitis due to E coli.

Norfloxacin (Noroxin)

 

Norfloxacin is a fluoroquinolone with activity against pseudomonads, streptococci, MRSA, S epidermidis, and most gram-negative organisms but no activity against anaerobes. It inhibits bacterial DNA synthesis and, consequently, growth. Norfloxacin is indicated for prostatitis due to E coli and UTIs.

Trimethoprim (Proloprim, Trimpex)

 

Trimethoprim is a dihydrofolate reductase inhibitor that prevents tetrahydrofolic acid production in bacteria. This agent is active in vitro against a broad range of gram-positive and gram-negative bacteria, including uropathogens such as Enterobacteriaceae and Staphylococcus saprophyticus. Resistance is usually mediated by decreased cell permeability or alterations in the amount or structure of dihydrofolate reductase.

Trimethoprim also demonstrates synergy with sulfonamides, potentiating the inhibition of bacterial tetrahydrofolate production.

Trimethoprim-sulfamethoxazole (Bactrim, Bactrim DS, Septra, Septra DS)

 

Trimethoprim-sulfamethoxazole (TMP-SMZ) is a combination antimicrobial agent designed to take advantage of synergy between TMP and sulfonamides. The antibacterial activity of TMP-SMZ includes common urinary tract pathogens, except Pseudomonas aeruginosa.

SMZ inhibits dihydropteroate synthetase, preventing incorporation of para-aminobenzoic acid (PABA) into dihydrofolate and subsequent synthesis of tetrahydrofolate. This agent has broad bacteriostatic activity against aerobic gram-positive and gram-negative organisms, with little activity against anaerobes; unfortunately, SMZ does not penetrate well into the kidney.

Ampicillin (Omnipen, Polycillin, Principen)

 

Ampicillin is an aminopenicillin beta lactam that impairs cell wall synthesis in actively dividing bacteria by binding to and inhibiting penicillin-binding proteins in the cell wall. This agent has enhanced activity against anaerobes and gram-negative aerobes and is generally used in combination with an aminoglycoside for empiric or directed activity against E faecalis urinary tract infections (UTIs).

Amoxicillin (Moxatag, Trimox)

 

Amoxicillin is a penicillin antibiotic that interferes with the synthesis of cell wall mucopeptides during active multiplication, resulting in bactericidal activity against susceptible bacteria.

Gentamicin (Garamycin, Gentacidin)

 

Gentamicin is a bactericidal aminoglycoside antibiotic that inhibits bacterial protein synthesis by binding to the ribosome. This agent has activity against a variety of aerobic gram-negative bacteria, as well as E faecalis and staphylococcal species, and it is used with or without ampicillin to treat acute prostatitis in the hospitalized patient when Enterococcus is a concern. Gentamicin is the only aminoglycoside with appreciable activity against gram-positive organisms.

The dosing regimens for gentamicin are numerous. Adjust the dose based on creatinine clearance (CrCl) and changes in the volume of distribution. Ideal body weight (IBW) should be used for calculations (the drug is not fat soluble).

Trough serum levels should be monitored to ensure adequate clearance and reduce toxicity (< 2 mcg/mL). Peak levels should also be monitored after 4-5 half-lives when it is dosed more often than once daily (qd).

Once-daily dosing should only be used when treating gram-negative infections, as this takes advantage of its concentration-dependent killing and its postantibiotic effect. However, gentamicin exhibits neither of these properties against gram-positive infections. (For synergy against gram-positive organisms, use 1 mg/kg q8h).

Ceftriaxone (Rocephin)

 

Ceftriaxone is a third-generation cephalosporin that has a broad gram-negative spectrum, lower efficacy against gram-positive organisms, and higher efficacy against resistant organisms. By binding to 1 or more penicillin-binding proteins, this agent arrests bacterial cell wall synthesis and inhibits bacterial growth.

Ceftazidime (Fortaz, Tazicef)

 

Ceftazidime is a third generation cephalosporin and a bactericidal agent that exerts its effect by inhibiting the enzymes responsible for cell wall synthesis. Caution should be used with this agent, as nephrotoxicity has been reported following concomitant administration of cephalosporins with aminoglycoside antibiotics or potent diuretics such as furosemide.

In addition, chloramphenicol has been demonstrated to be antagonistic to beta-lactam antibiotics, including ceftazidime, based on in vitro studies and time kill curves with enteric gram-negative bacilli. Because of the possibility of antagonism in vivo, particularly when bactericidal activity is desired, avoid this drug combination.

Tobramycin (TOBI)

 

Tobramycin is an aminoglycoside used for gram-negative bacterial coverage, with better pseudomonal coverage than gentamicin. This agent is commonly used in combination with agents against gram-positive organisms and those that cover anaerobes.

Consider using tobramycin when penicillins or other less-toxic drugs are contraindicated, when bacterial susceptibility tests and clinical judgment indicate its use, and in mixed infections caused by susceptible strains of staphylococci and gram-negative organisms. Its dosing regimens are numerous and are adjusted based on the CrCl and changes in the volume of distribution.

Erythromycin (Erythrocin, Ery-Tab)

 

Erythromycin is a macrolide antibiotic that inhibits bacterial growth, possibly by blocking dissociation of peptidyl transfer ribonucleic acid (tRNA) from ribosomes, causing RNA-dependent protein synthesis to arrest. It is used for the treatment of staphylococcal and streptococcal infections.

Vancomycin (Vancocin, Vibra-Tabs)

 

Vancomycin is a potent antibiotic directed against gram-positive organisms and active against Enterococcus species. It is indicated for patients who cannot receive or have failed to respond to penicillins and cephalosporins or who have infections with resistant staphylococci. It is used in conjunction with gentamicin for prophylaxis in penicillin-allergic patients undergoing gastrointestinal or genitourinary procedures.

Doxycycline (Vibramycin, Vibra-Tabs)

 

Doxycycline is a broad-spectrum, bacteriostatic antibiotic in the tetracycline class. It inhibits protein synthesis and, thus, bacterial growth by binding to the 30S and, possibly, the 50S ribosomal subunits of susceptible bacteria. It may block dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Ertapenem (Invanz)

 

Ertapenem has bactericidal activity from inhibition of cell wall synthesis, which is mediated through ertapenem binding to penicillin-binding proteins. This agent is stable against hydrolysis by a variety of beta lactamases, including penicillinases, cephalosporinases, and extended-spectrum beta lactamases. Ertapenem is hydrolyzed by metallo–beta lactamases.

Aztreonam (Azactam, Cayston)

 

Aztreonam is a monobactam that inhibits cell wall synthesis during bacterial growth. It is active against gram-negative bacilli but has very limited gram-positive activity and is not useful against anaerobes. It lacks cross sensitivity with beta-lactam antibiotics, and it may be used in patients allergic to penicillins or cephalosporins.

Nitrofurantoin (Macrodantin, Furadantin)

 

Nitrofurantoin is a bactericidal antibiotic indicated for acute cystitis and UTIs caused by E coli, enterococci, S aureus, and strains of Klebsiella and Enterobacter species.

Rifampin (Rifadin)

 

Rifampin is an antituberculosis agent that inhibits RNA synthesis in bacteria by binding to the beta subunit of DNA-dependent RNA polymerase, which, in turn, blocks RNA transcription.

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Analgesics, Urinary

Class Summary

Urinary analgesics, such as phenazopyridine, can help to treat the symptoms of dysuria.

Phenazopyridine

 

Phenazopyridine is compatible with antibacterial therapy and can help to relieve pain and discomfort before antibacterial therapy controls infection. It is used for symptomatic relief of pain, burning, urgency, frequency, and other discomfort arising from irritation of the lower urinary tract mucosa caused by infection, trauma, surgery, endoscopic procedures, or passage of sounds or catheters. The analgesic action may reduce or eliminate the need for systemic analgesics or narcotics.

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Contributor Information and Disclosures
Author

John L Brusch, MD, FACP Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Burke A Cunha, MD Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgements

Bryan P Blair, MD Staff Physician, Department of Urology, Naval Medical Center at Portsmouth

Disclosure: Nothing to disclose.

David S Howes, MD Professor of Medicine and Pediatrics, Section Chief and Emergency Medicine Residency Program Director, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

David S Howes, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physicians-American Society of Internal Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Klaus-Dieter Lessnau, MD, FCCP Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Sepracor None None

Mark Jeffrey Noble, MD Consulting Staff, Urologic Institute, Cleveland Clinic Foundation

Mark Jeffrey Noble, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Kansas Medical Society, Sigma Xi, Society of University Urologists, and Southwest Oncology Group

Disclosure: Nothing to disclose.

M Tyson Pillow, MD Assistant Director of Medical Education, Ben Taub General Hospital Emergency Center; Assistant Professor, Baylor College of Medicine

M Tyson Pillow, MD is a member of the following medical societies: Air Medical Physician Association, American College of Emergency Physicians, American Medical Association, American Medical Student Association/Foundation, Emergency Medicine Residents Association, Society for Academic Emergency Medicine, and Student National Medical Association

Disclosure: Nothing to disclose.

Joseph A Salomone III, MD Associate Professor and Attending Staff, Truman Medical Centers, University of Missouri-Kansas City School of Medicine; EMS Medical Director, Kansas City, Missouri

Joseph A Salomone III, MD is a member of the following medical societies: American Academy of Emergency Medicine, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Richard H Sinert, DO Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Cindy L Tamminga, MD Consulting Staff, Division of Infectious Diseases, Naval Medical Center at Portsmouth

Disclosure: Nothing to disclose.

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Prostatic calcifications in a male with a urinary tract infection.
Bladder calculi in a male with a urinary tract infection.
 
 
 
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