What are the treatment options for prostatitis (inflammation of the prostate gland)?

From the Guidelines

Prostatitis treatment should be guided by the type of prostatitis, with acute bacterial prostatitis typically requiring antibiotics for 2-4 weeks, and chronic bacterial prostatitis requiring longer courses, often 4-12 weeks, although optimal durations are unknown due to limited evidence 1.

Treatment Approach

The treatment approach for prostatitis varies depending on whether it is acute or chronic and whether it is bacterial or non-bacterial in nature.

• For acute bacterial prostatitis (ABP), the treatment typically involves antibiotics, but the optimal duration of treatment is not well established due to insufficient quality of evidence 1.
• For chronic bacterial prostatitis (CBP), the treatment also involves antibiotics, but again, the optimal duration of treatment is unknown and requires further study 1.

Non-Bacterial Prostatitis

For non-bacterial prostatitis, also known as chronic pelvic pain syndrome, the treatment focuses on symptom relief rather than curing an infection.

• This can include the use of alpha-blockers like tamsulosin, anti-inflammatory medications such as ibuprofen, and muscle relaxants to help manage symptoms.
• Supportive measures such as warm sitz baths, increased fluid intake, avoiding irritants like caffeine and alcohol, and pelvic floor physical therapy can also be beneficial.

Considerations

It's crucial for patients to complete the full course of antibiotics as prescribed, even if symptoms improve early, to ensure the infection is fully cleared.

• Follow-up with a healthcare provider is necessary if symptoms persist or worsen despite treatment, as this may indicate a need to adjust the treatment plan.
• The role of prostate-specific antigen (PSA) testing and maneuvers like prostate massage is limited in the diagnosis and management of prostatitis, and urology consultation may be necessary for complex cases 1.

From the FDA Drug Label

1. 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)].
2. 6 Chronic Bacterial Prostatitis Adult patients with a clinical diagnosis of prostatitis and microbiological culture results from urine sample collected after prostatic massage (VB3) or expressed prostatic secretion (EPS) specimens obtained via the Meares-Stamey procedure were enrolled in a multicenter, randomized, double-blind study comparing oral levofloxacin 500 mg, once daily for a total of 28 days to oral ciprofloxacin 500 mg, twice daily for a total of 28 days.

Levofloxacin is indicated for the treatment of chronic bacterial prostatitis due to Escherichia coli, Enterococcus faecalis, or methicillin-susceptible Staphylococcus epidermidis. The recommended treatment duration is 28 days with a dose of 500 mg once daily 2 2.

• Key points:
  • Indication: Chronic bacterial prostatitis
  • Pathogens: Escherichia coli, Enterococcus faecalis, methicillin-susceptible Staphylococcus epidermidis
  • Treatment duration: 28 days
  • Dose: 500 mg once daily

From the Research

Prostatitis Treatment Options

• Prostatitis is a collection of signs and symptoms that occur as a result of inflammation or swelling of the prostate gland, and effective treatment often depends on identification of the cause 3.
• Bacterial prostatitis can be acute or chronic, and always requires some degree of antimicrobial therapy, with fluoroquinolones being the preferred agents for most patients due to their ability to penetrate the prostate tissue 3, 4, 5.
• For chronic prostatitis, a stepwise approach to therapy involving antibiotics followed by bioflavonoids and then α-blockers appears to effectively reduce symptoms for up to 1 year in patients with chronic prostatitis 3.
• α-blockers, such as tamsulosin, terazosin, and alfuzosin, have been shown to be effective in reducing symptoms in patients with chronic prostatitis, particularly those with urinary symptoms 3, 6.
• Anti-inflammatory agents, such as non-steroidal anti-inflammatory drugs (NSAIDs), may also be used to reduce pain and inflammation in patients with chronic prostatitis 4, 6.
• Phytotherapy, including quercetin, pollen extract, and extract of Serenoa repens, has been shown to have a positive effect on symptoms and quality of life in patients with chronic prostatitis 4.
• Dietary changes, such as regulating the balance of intestinal flora, may also be beneficial in reducing symptoms of chronic prostatitis 4.

Treatment of Specific Types of Prostatitis

• Acute bacterial prostatitis can be treated with intravenous administration of high doses of bactericidal antimicrobials, such as broad-spectrum penicillins, third-generation cephalosporins, or fluoroquinolones, in combination with an aminoglycoside 4.
• Chronic bacterial prostatitis can be treated with fluoroquinolones, such as ciprofloxacin, levofloxacin, or ofloxacin, for 2 to 4 weeks, which can cure about 70% of men with chronic bacterial prostatitis 4, 5.
• Chlamydial prostatitis can be treated with macrolides, such as azithromycin, which have been shown to be more effective than fluoroquinolones 5.

Multidisciplinary Approach to Prostatitis

• A multidisciplinary approach to prostatitis, including urologists, pain management specialists, and physical therapists, may be beneficial in reducing symptoms and improving quality of life in patients with chronic prostatitis 4.
• Pelvic floor physical therapy may be a useful second-line therapy for patients with chronic prostatitis, particularly those with pelvic floor dysfunction 6.