Discussion: Discuss the difference in antibiotic treatment for urinary tract infections in men vs. women

Discussion: Discuss the difference in antibiotic treatment for urinary tract infections in men vs. women

Discussion: Discuss the difference in antibiotic treatment for urinary tract infections in men vs. women

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Women’s Health Week 9r2

Treatment recommendations for urinary tract infections (UTIs) differ for males and females, primarily regarding the duration of treatment. The current antimicrobial prescribing guidelines indicate that male and female patients with UTIs should be treated with the same antimicrobials but for different durations. For instance, the Irish antimicrobial guidelines for treating UTIs recommend therapy for females and males with the same first-line antimicrobials (Nitrofurantoin and Trimethoprim) but different durations, three days in females and seven days in males (Tandan et al., 2018). The different durations of antimicrobial therapy are based on a common conception in general practice that males generally have complicated UTIs.  Therefore treatment recommendations for uncomplicated UTIs in women are not appropriate for men.

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As a general rule, all UTIs in males are considered complicated. Thus, the possibility that the infection has ascended to the kidneys must be considered, and the treatment regimens must presume that an upper urinary tract infection has occurred. UTI treatment guidelines in the US recommend that adult males with UTIs be prescribed a 10- to 14-day course of antibiotics. Outpatient medication regimens include fluoroquinolone, trimethoprim-sulfamethoxazole, minocycline, or nitrofurantoin (Chu & Lowder, 2018). However,  nitrofurantoin should not be prescribed to patients with a glomerular filtration rate < 50. Inpatient treatment regimens include intravenous antimicrobial therapy with a third-generation cephalosporin, such as ceftriaxone; a fluoroquinolone like ciprofloxacin; or an aminoglycoside.

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On the other hand, the first-line therapy for uncomplicated UTI in females includes trimethoprim/sulfamethoxazole for 3 days; Nitrofurantoin for 5-7 days; and Fosfomycin single dose. Complicated UTIs in females are treated for 7-14 days with treatment regimens like oral Ciprofloxacin and Levofloxacin (Chu & Lowder, 2018). Intravenous formulations are used in patients who cannot tolerate oral therapy, including Ciprofloxacin, Levofloxacin, ampicillin, meropenem, piperacillin-tazobactam, and doripenem.

References

Chu, C. M., & Lowder, J. L. (2018). Diagnosis and treatment of urinary tract infections across age groups. American journal of obstetrics and gynecology, 219(1), 40-51. https://doi.org/10.1016/j.ajog.2017.12.231

Tandan, M., Duane, S., Cormican, M., Murphy, A. W., & Vellinga, A. (2018). Reconsultation and Antimicrobial Treatment of Urinary Tract Infection in Male and Female Patients in General Practice. Antibiotics (Basel, Switzerland), 5(3), 31. https://doi.org/10.3390/antibiotics5030031

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