Treatment of uncomplicated UTI in males: a systematic review of the literature.

Farrell, Karen; Tandan, Meera; Chidwick, Kendal; Gagyor, Ildiko; Braend, Anja Maria; Skow, Marius; Vik, Ingvild; Jansaaker, Filip; Hayward, Gail; Vellinga, Akke

BACKGROUND Urinary tract infections (UTI) affect around 20% of the male population in their lifetime. The incidence of UTI in men in the community is 0.9 to 2.4 cases per 1,000 under the age of 55 years and 7.7 per 1,000 over 85 years. AIM To evaluate the outcomes of randomised controlled trials (RCTs) comparing the effectiveness of different antimicrobial treatments and durations for uncomplicated UTIs in adult males in outpatient settings. METHOD RCTs of adult male patients with an uncomplicated UTI treated with oral antimicrobials in any outpatient setting. The outcomes were symptom resolution within two weeks of starting treatment, duration until symptom resolution, clinical cure, bacteriological cure and frequency of adverse events. RESULTS From the 1041 abstract screened, 3 provided sufficient information on outcomes. One study compared trimethoprim-sulfamethoxazole for 14 days with 42 days in 2*21 males. Fluoroquinolones were compared in the two other studies: lomefloxacin (10 males) with norfloxacin (11 males), and ciprofloxacin for 7 and 14 days (2*19 males). Combining the results from the three studies shows that for 75% males with a UTI (76/101) bacteriological cure was reported at the end of the study. Of the 59 patients receiving a fluoroquinolone, 57 (97%) reported bacteriological and clinical cure within 2 weeks after treatment. CONCLUSION The evidence available is insufficient to make any recommendations in relation to type and duration of antimicrobial treatment for male UTIs. Sufficiently powered RCTs are needed to identify best treatment type and duration for male UTIs in primary care.