Empirical antibiotic therapy for acute cystitis in adult males

Acute cystitis in males is uncommon and there is less evidence to guide antibiotic therapy than for females¹. Antibiotic recommendations for males with acute cystitis are extrapolated from the recommendations for nonpregnant females.

See Approach to empirical antibiotic choice for UTI in adults and Rationale for empirical antibiotic therapy for acute cystitis in adults for a discussion of antibiotic choice.

For males in whom prostatitis is suspected, see Acute bacterial prostatitis for management.

For empirical therapy for acute cystitis in males in whom prostatitis is unlikely, while awaiting the results of urine culture, use:

1nitrofurantoin 100 mg orally, 6-hourly for 7 days² ³ ⁴. For dosage adjustment in adults with kidney impairment, see nitrofurantoin dosage adjustment nitrofurantoin

2trimethoprim 300 mg orally, daily for 7 days⁵. For dosage adjustment in adults with kidney impairment, see trimethoprim dosage adjustment. trimethoprim

If nitrofurantoin and trimethoprim cannot be used, for empirical therapy for acute cystitis in adult males in whom prostatitis is unlikely, use:

cefalexin 500 mg orally, 12-hourly for 7 days. For dosage adjustment in adults with kidney impairment, see cefalexin dosage adjustment. cefalexin

Limited evidence indicates fosfomycin may be an option for the treatment of acute cystitis in adult malesBouiller, 2022. More information is needed before it can be recommended.

If urine culture and susceptibility testing indicate the pathogen is resistant to empirical therapy, do not modify the antibiotic therapy if symptoms of cystitis are improving. If the pathogen is resistant to empirical therapy and symptoms of cystitis are not improving, use the narrowest spectrum antibiotic to which the pathogen is susceptible.

Do not perform post-treatment urine culture to confirm resolution of infection for asymptomatic males with acute cystitisDrekonja, 2013.

For patients with ongoing cystitis symptoms following appropriate antibiotic therapy, consider seeking expert urology advice.

¹ In this topic, the term ‘female’ is used to include all people presumed female at birth.Return

² Do not use nitrofurantoin if prostatitis is a possibility, because therapeutic concentrations of nitrofurantoin are not reached in the prostate.Return

³ An alternative regimen is 100 mg 12-hourly for 7 days. This is from a study using Macrobid^®, a slow-release formulation unavailable in Australia.Return

⁴ Retrospective data suggest that nitrofurantoin is safe and effective for short-term treatment (5 to 7 days) of acute cystitis in patients with a glomerular filtration rate (GFR) of 30 mL/min or moreCunha, 2017 Geerts, 2013 Santos, 2016 Singh, 2015. Return

⁵ If the patient has been treated with trimethoprim in the previous 3 months, or had a trimethoprim-resistant Escherichia coli isolate during this time, use an alternative antibiotic for empirical therapy.Return