From the FDA Drug Label
- 8 Chronic Bacterial Prostatitis Levofloxacin tablets are indicated for the treatment of chronic bacterial prostatitis due to Escherichia coli, Enterococcus faecalis, or methicillin-susceptible Staphylococcus epidermidis [see Clinical Studies (14.6)].
The recommended antibiotics for the treatment of prostatitis are:
- Levofloxacin: for the treatment of chronic bacterial prostatitis due to Escherichia coli, Enterococcus faecalis, or methicillin-susceptible Staphylococcus epidermidis 1
- Ciprofloxacin: for the treatment of chronic bacterial prostatitis, as a comparator to levofloxacin in clinical studies 1 1
From the Research
Fluoroquinolones, particularly levofloxacin, are the first-line antibiotics for treating prostatitis, with a recommended regimen of 500 mg once daily for 4-6 weeks. The choice of levofloxacin is based on its excellent penetration into prostate tissue and broad spectrum of activity against common prostate pathogens, as demonstrated in a study published in 2012 2. This study showed that levofloxacin had a higher bacterial clearance rate and clinical efficacy compared to ciprofloxacin, with a lower rate of adverse events.
The typical treatment regimens for prostatitis are:
- Levofloxacin 500 mg once daily for 4-6 weeks
- Ciprofloxacin 500 mg twice daily for 4-6 weeks (although levofloxacin is preferred due to its better efficacy and safety profile)
If fluoroquinolones are contraindicated or ineffective, alternatives include:
- Trimethoprim-sulfamethoxazole (TMP-SMX) 160/800 mg twice daily for 4-6 weeks
- Doxycycline 100 mg twice daily for 4-6 weeks
It's crucial to complete the full course of antibiotics, even if symptoms improve earlier, to prevent recurrence and antibiotic resistance. Patients should also increase fluid intake and may benefit from anti-inflammatory medications for pain relief. The extended treatment duration is necessary because of the difficulty in achieving adequate antibiotic concentrations within the prostate gland.
A study published in 2008 3 demonstrated the efficacy and safety of levofloxacin in patients with chronic bacterial prostatitis, with a clinical success rate of 92% and a microbiological eradication rate of 83.7%. Another study published in 2011 4 reviewed the identification and treatment options for prostatitis, including pharmacologic and nonpharmacologic interventions, and highlighted the importance of fluoroquinolones in the treatment of bacterial prostatitis.
If symptoms persist after initial treatment, further evaluation may be needed to rule out other conditions or antibiotic-resistant infections.