Urinary Tract Infection (UTI) in Males Guidelines

Updated: Mar 27, 2023
  • Author: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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Initial Choice of Antibiotic Regimen and Considerations for FollowUP

Fluoroquinolone resistance has dramatically risen throughout the world. The major approach to dealing with this has been to restrict their use, often by limiting the duration of therapy. This can result in suppressing the infectious process that may flare up months later with the same pathogen. By that time, the organism may have become totally or partially resistant.

In addition, the required rate of adherence is impossible to achieve with the growing numbers of health care providers (eg, Nurse Practitioners) who have prescriptive powers.

The monitoring process of antibiotic therapy remains very basic. It is based on signs and symptoms such as clinical appearance, body temperature, and urine/ blood cultures along with the occasional measurement of CRP or sedimentation rate. These often do not have the capability to detect the ongoing inflammatory response of the patient to the sequestered pathogens. Failure to do so may transform the acute process into a chronic one. Testing for other inflammatory products will certainly increase the yield. Since such are not routinely tested for, the challenge is to survey these markers and then develop devices for screening. [28]  

It is only fairly recently that the important role that the intestinal microbiome plays in recurrent UTIs has become known. The term microbiome refers to a community of microbes that live in a defined part of the body such as the GI tract or oral cavity. The term also refers to the essential role in maintaining human health. The normal flora of the gut eradicate pathogens that have infected the gut but also other parts of the body.

At times, the invader is able to migrate from the mucosa into the wall of gut where it may remain dormant. So protected from the host's immune system, it may develop mutations(dysbiosis) that allow it to escape and reinfect the urinary tract. This recurrence defines the Gut-Bladder Axis, [29] and this is why antimicrobial resistance is ever growing to the point of possibly ending the antibiotic era.

Fortunately, substances such as D- mannose exist that do prevent bacteria from adhering and invading the gut uroepithelial cells. As with antibiotics, their effectiveness is target dependent. [30]