From the Guidelines
Acute bacterial prostatitis requires prompt antibiotic treatment, with fluoroquinolones such as ciprofloxacin 500mg twice daily or levofloxacin 500mg once daily for 2-4 weeks being the recommended first-line therapy. The diagnosis of acute bacterial prostatitis relies on clinical presentation and laboratory tests, including urinalysis and urine culture 1.
Clinical Presentation and Diagnosis
The clinical presentation of acute bacterial prostatitis often includes febrile UTI symptoms, and diagnosis involves comparing bacteria levels in prostatic fluid and urinary cultures 1. However, the optimal durations of treatment for acute bacterial prostatitis are unknown and have not been established by high-quality studies 1.
Treatment Options
Alternative options for treatment include trimethoprim-sulfamethoxazole (TMP-SMX) 160/800mg twice daily for the same duration 1. For severe cases requiring hospitalization, initial treatment should be intravenous antibiotics like ceftriaxone 1-2g daily plus an aminoglycoside, transitioning to oral therapy once improved 1.
Additional Management
Pain management with NSAIDs like ibuprofen 400-600mg three times daily is important, and alpha-blockers such as tamsulosin 0.4mg daily may help with urinary symptoms 1. Patients should increase fluid intake to 2-3 liters daily and avoid alcohol, caffeine, and spicy foods which can worsen symptoms. Warm sitz baths for 10-15 minutes several times daily can provide relief. Most cases resolve completely with appropriate treatment, but inadequate therapy may lead to chronic prostatitis or abscess formation. The infection typically occurs when bacteria from the urinary tract ascend to the prostate, with E. coli being the most common pathogen, though other gram-negative and some gram-positive bacteria can be involved 1.
Key Considerations
- Increase fluid intake to 2-3 liters daily
- Avoid alcohol, caffeine, and spicy foods
- Use warm sitz baths for 10-15 minutes several times daily
- Consider pain management with NSAIDs and alpha-blockers
- Transition to oral therapy once improved in severe cases requiring hospitalization
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 symptoms of acute bacterial prostatitis can include pelvic pain, dysuria, urinary frequency, and urinary retention, as well as systemic symptoms such as fevers, chills, and malaise.
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.
- The physical examination should include abdominal, genital, and digital rectal examination to assess for a tender, enlarged, or boggy prostate 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.
Classification and Diagnosis of Prostatitis
- Prostatitis can be classified into four categories: acute bacterial, chronic bacterial, chronic prostatitis/chronic pelvic pain syndrome, and asymptomatic 3.
- Diagnosis of acute and chronic bacterial prostatitis is primarily based on history, physical examination, urine culture, and urine specimen testing pre- and post-prostatic massage 3.
Treatment of Chronic Bacterial Prostatitis
- The mainstay of therapy is an antimicrobial regimen 3.
- Treatment of chronic bacterial prostatitis with levofloxacin and ciprofloxacin has been shown to lower serum prostate specific antigen (PSA) 4.
- Approximately 42% of patients with increased baseline PSA had a post-therapy PSA of 4 ng/ml or less after treatment with levofloxacin or ciprofloxacin 4.