New findings on antibiotic choice for urinary tract infections in men

Urinary tract infections in men are often treated with antibiotics that act on a wide range of bacteria. While this can be effective, it also carries a risk of promoting resistance. In this study, the researchers compared outcomes between treatment with broad-spectrum antibiotics and narrow-spectrum agents directed at the bacteria that most commonly cause urinary tract infections. The broad-spectrum antibiotics used in the comparison belonged to the quinolone group, a type of antibiotic frequently used for urinary infections but known to contribute to resistance development.

Large dataset from primary care

The study included around 40,000 men in Västra Götaland who were treated for uncomplicated urinary tract infection without fever in primary care between 2012 and 2019. The researchers followed the patients for 30 days after treatment to see whether the infection recurred or if any serious complications, such as fever, prostatitis or sepsis, occurred.

“Sepsis was very rare, only about a hundred cases in the entire material, which speaks for itself. The differences between the groups were so small that they do not justify treatment with broad-spectrum antibiotics,” says Christina “Tinna” Åhrén, researcher at the University of Gothenburg and regional medical officer. She emphasises that these antibiotics not only drive resistance development but can also cause undesirable side effects.

Narrow-spectrum antibiotics a safe first-line option

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The researchers conclude that narrow-spectrum antibiotics are often a safe first-line choice for uncomplicated urinary tract infections in men. Swedish guidelines were revised as early as 2013, and the study indicates that this recommendation is well-founded. In 2019, just over half of all Swedish men with urinary tract infections received such treatment.

“It always takes time to change prescribing patterns in healthcare,” says Tinna Åhrén. “Knowledge and confidence among prescribing doctors are crucial, as is ensuring that the entire healthcare organisation is working towards the same goal. We know that primary care centres with good continuity and strong leadership are most successful in achieving sustainable antibiotic use.”

The researchers stress that the results apply to uncomplicated urinary tract infections without fever. In more complicated cases, or in patients with underlying conditions or fever, broader antibiotics should still be used.

“Since urinary tract infections are so common, it is important to use narrow-spectrum antibiotics whenever possible. It is one of several key measures to slow the development of resistance,” says Ti