These are the responses and a discussion of a case quiz – Dysuria in men.
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UTIs in men
The convention of calling all UTIs in men “complicated” is simplistic but does signify the need to think differently about the diagnosis and therapy in men vs. women. Cystitis is women is the most common form of UTI and often very easily treated. “Cystitis” in men is very often accompanied by acute prostatitis that is difficult to diagnose and difficult to treat. If acute prostatitis progresses to chronic prostatitis it becomes one of the most difficult-to-treat conditions known. For this reason I believe that it is safer to assume prostatitis is always present.
Of the available choices I believe that either TMP/SMX or ciprofloxacin for 3 weeks are most appropriate. Both agents achieve excellent levels in prostate and are “tried and true” for this indication. A three week prescribed course is likely to achieve about a 2 week average course with compliance in men being less than perfect. In the practical sense, if follow-up is assured, a short course could be prescribed that would allow for the completion of culture and susceptibility with specific therapy then prescribed to complete the course.
Men don’t get cystitis, they get prostatitis.