Burning pain, frequent trips to the toilet, urine that’s cloudy and strong-smelling—such symptoms suggest a urinary tract infection (UTI). If you’re a man, when you go to your doctor for antibiotics, there’s almost no way of knowing how many days’ worth of pills you’ll be prescribed…because chances are that your doctor doesn’t know what’s best.

That’s a problem. Treat a UTI too briefly, and there’s a risk that the bacteria may survive to invade your kidneys and do serious damage. Treat the infection too long, and you’re more likely to experience side effects from the drugs (including severe dizziness and even ruptured tendons)…and, according to a new study, you also encourage your UTI to return and boost your odds of developing a nasty colon infection as well.

Why all the confusion? Because there is scant research into the optimal length of time to treat men who have UTIs. Up to about age 50, UTIs are so much more common in women than men that the research has focused mostly on women. Based on numerous studies of women, the Infectious Diseases Society of America concluded that the optimal length of antibiotic therapy for women with UTIs is usually three days.

There is no similar research-based guideline for men, so doctors often make the assumption that, because men’s urethras are longer than women’s, their treatment time should be longer, too. Yet the actual number of days prescribed varies widely from doctor to doctor. For instance, the new study found that treatment times often ranged anywhere from three days to 30 days—and “there didn’t seem to be much rhyme or reason as to why,” said lead author Dimitri Drekonja, MD, a staff physician at the Minneapolis Veterans Affairs (VA) Health Care System. That’s why he and his colleagues set out to study the situation.


Dr. Drekonja’s team sifted through data on 33,336 male VA patients nationwide who had developed one or more UTIs, comparing recurrence rates and complications for patients who received shorter-duration antibiotic treatment (seven days or less) with those who received longer treatment (more than seven days). What they found…

  • UTIs recurred after 30 or more days in 11% of men given the longer treatment, but in just 8% of those given the shorter treatment. (Recurrence rates prior to 30 days were similar in both groups.)
  • Men who received the longer treatment were nearly twice as likely as those treated for less time to develop an infection of Clostridium difficile (C. difficile). This bacterium can take hold when antibiotics wipe out beneficial bacteria in the gut, leading to inflammation of the colon, severe diarrhea, abdominal pain and/or fever.

Of course, it’s possible that some of the patients who were given the longer course of treatment also had the most severe UTIs, in which case it makes sense that they would be at highest risk for recurrence. Still, the study does suggest that many men are being treated for longer than is ideal—and that such extended treatment has serious side effects.

Unfortunately, the confusion about optimal UTI treatment duration will continue until additional research provides insights on which to base more specific guidelines. In the meantime, though, men do have another option…


If you’re a guy with a UTI, you may be able to avoid antibiotics altogether by taking a more natural approach to treatment that includes the use of supplements, said Andrew Rubman, ND, medical director of the Southbury Clinic for Traditional Medicines in Southbury, Connecticut. You would need to consult a naturopathic physician to confirm your diagnosis and determine appropriate dosages.

With his own patients, Dr. Rubman explained, an important step is to make the environment of the urinary tract more acidic so that E. coli (the bacterium most commonly associated with UTIs) cannot thrive. With that goal in mind, he often prescribes a concentrated cranberry extract. Cranberry not only makes urine more acidic, but it also contains substances called proanthocyanidins that keep the bacteria from binding to the urinary tract. Another acidity booster is powdered vitamin C (ascorbic acid). Dark berry extracts, as a broad-based proanthocyanidins source, may also be prescribed. (Dr. Rubman’s favorite is Nutragenomic Berry POW-der from Eclectic Institute, www.EclecticHerb.com.) In addition, patients may be advised to drink more water to help flush out the urinary tract.

Even if natural therapies don’t cure you and you do end up needing an antibiotic, your naturopathic doctor will want to do a urine test to determine which specific organisms are causing you trouble. Dr. Rubman said, “Another bacterial infection in your body could be what made you vulnerable to a UTI in the first place, so that should be addressed. Plus, it’s helpful to identify the UTI organism in order to know which antibiotic will work best and to gauge the most appropriate length of treatment.”