From the Guidelines
Acute bacterial prostatitis requires prompt antibiotic treatment, and the recommended first-line therapy is a fluoroquinolone such as ciprofloxacin 500mg twice daily or levofloxacin 500mg once daily for 2-4 weeks, as supported by the most recent guidelines 1.
Diagnosis and Presentation
The diagnosis of acute bacterial prostatitis involves clinical presentation and laboratory tests, including urinalysis, urine culture, and blood tests 1. Patients typically present with fever, chills, lower back pain, perineal discomfort, urinary symptoms (frequency, urgency, dysuria), and sometimes urinary retention. A digital rectal examination may reveal a tender, swollen prostate.
Treatment Approach
The optimal duration of treatment for acute bacterial prostatitis is unknown and has not been established by high-quality studies 1. However, based on the available evidence, a fluoroquinolone or trimethoprim-sulfamethoxazole (TMP-SMX) for 2-4 weeks is a reasonable approach. Hospitalization may be necessary for severe cases requiring intravenous antibiotics like ampicillin plus gentamicin or a third-generation cephalosporin.
Supportive Measures
Pain management with NSAIDs, adequate hydration, and stool softeners are important supportive measures. Urinary retention may require temporary catheterization, preferably with a suprapubic catheter to avoid traumatizing the inflamed prostate. Patients should complete the full antibiotic course even after symptoms improve to prevent recurrence or progression to chronic infection.
Key Considerations
- The choice of antibiotic should be based on local resistance patterns and susceptibility testing 1.
- Patients with severe cases or those who do not respond to initial treatment may require further evaluation and adjustment of their treatment plan 1.
- The infection typically responds well to appropriate antibiotics, but inadequate treatment can lead to chronic prostatitis or prostatic abscess.
From the Research
Definition and Symptoms of Acute Bacterial Prostatitis
- Acute bacterial prostatitis is an acute infection of the prostate gland that causes pelvic pain and urinary tract symptoms, such as dysuria, urinary frequency, and urinary retention, and may lead to systemic symptoms, such as fevers, chills, nausea, emesis, and malaise 2.
- The condition is estimated to comprise approximately 10% of all cases of prostatitis 2.
Diagnosis of Acute Bacterial Prostatitis
- Diagnosis is predominantly made based on history and physical examination, but may be aided by urinalysis 2.
- Urine cultures should be obtained in all patients who are suspected of having acute bacterial prostatitis to determine the responsible bacteria and its antibiotic sensitivity pattern 2.
- Additional laboratory studies can be obtained based on risk factors and severity of illness 2.
- Radiography is typically unnecessary 2.
Treatment of Acute Bacterial Prostatitis
- Most patients can be treated as outpatients with oral antibiotics and supportive measures 2.
- Hospitalization and broad-spectrum intravenous antibiotics should be considered in patients who are systemically ill, unable to voluntarily urinate, unable to tolerate oral intake, or have risk factors for antibiotic resistance 2.
- Typical antibiotic regimens include ceftriaxone and doxycycline, ciprofloxacin, and piperacillin/tazobactam 2.
- The choice of antibiotic regimen can impact the risk of relapse, with quinolones and intravenous beta-lactams having lower relapse rates than co-trimoxazole and oral beta-lactams 3.
Risk Factors for Relapse
- Inadequate antibiotic therapy is a significant risk factor for relapse in acute bacterial prostatitis 3.
- The use of oral beta-lactam and co-trimoxazole is associated with a higher risk of relapse compared to quinolones and intravenous beta-lactams 3.
- The overall resistance rate to quinolones is high, emphasizing the need for tailored antibiotic therapy based on microbiological susceptibility patterns 3.
Classification and Differential Diagnosis of Prostatitis
- Prostatitis can be classified into four categories: acute bacterial, chronic bacterial, chronic prostatitis/chronic pelvic pain syndrome, and asymptomatic 4.
- The differential diagnosis of prostatitis includes acute cystitis, benign prostatic hyperplasia, urinary tract stones, bladder cancer, prostatic abscess, enterovesical fistula, and foreign body within the urinary tract 4.