Antibiotic penetration in the male urinary tract: a critical review of pharmacokinetic and pharmacodynamic evidence.

To optimize the management of male urinary tract infections, it is essential to analyze the various pharmacokinetic and pharmacodynamic parameters in the different organs of the male urinary tract. In the literature, the quantity and quality of data vary considerably depending on the class of antibiotics and the methodological approaches used. Beta-lactams achieve effective concentrations in prostate tissue, the testes, and urine, but reach only limited levels in prostatic secretions. Fosfomycin reaches therapeutic concentrations in prostate tissue, prostatic secretions, seminal fluid, bladder tissue, and urine. Trimethoprim-sulfamethoxazole reaches effective concentrations in prostate tissue, the testes, and urine. Only trimethoprim reaches effective concentrations in prostatic secretions and seminal fluid. Fluoroquinolones have the most favorable pharmacokinetic and pharmacodynamic profile and achieve therapeutic concentrations in prostate tissue, prostate secretions, seminal fluid, the testes, bladder tissue, and urine, as well as excellent intracellular diffusion and significant antibiofilm activity. The pharmacokinetics of aminoglycosides in the prostate and testes remain poorly characterized, despite the high concentrations observed in the kidneys and urine. Nitrofurantoin achieves a low plasma concentration, indicating limited tissue distribution. Azithromycin and doxycycline exhibit significant concentrations in prostatic tissue. Further research is needed to enhance understanding of the pharmacokinetics and pharmacodynamics of antibiotics in the male urinary tract, particularly in the context of growing antibiotic resistance.