From the Guidelines
Acute prostatitis treatment for the first time should involve a 14-day course of antibiotics. The choice of antibiotic should be based on local resistance patterns and specific host factors, such as allergies 1. According to the European Association of Urology guidelines, the microbial spectrum of acute prostatitis is greater than that of uncomplicated urinary tract infections, and antimicrobial resistance is more likely 1.
Key Considerations
- The most common species found in cultures of acute prostatitis include E. coli, Proteus spp., Klebsiella spp., Pseudomonas spp., Serratia spp., and Enterococcus spp. 1
- A urine culture and susceptibility testing should be performed to guide the choice of antibiotic 1
- Initial empiric therapy should be tailored and followed by oral administration of an appropriate antimicrobial agent for the uropathogen isolated 1
- Pain management with nonsteroidal anti-inflammatory drugs (NSAIDs) and increased fluid intake are also important aspects of treatment
Treatment Duration
- A treatment duration of 14 days is generally recommended for men with acute prostatitis, as it cannot be excluded 1
- However, the duration of treatment should be closely related to the treatment of the underlying abnormality 1
- When the patient is hemodynamically stable and has been afebrile for at least 48 hours, a shorter treatment duration (e.g., 7 days) may be considered in cases where short-course treatment is desirable due to relative contraindications to the antibiotic administered 1
From the Research
Acute Prostatitis Treatment
- Acute bacterial prostatitis is an infection of the prostate gland that causes pelvic pain and urinary tract symptoms, such as dysuria, urinary frequency, and urinary retention 2.
- The diagnosis is predominantly made based on history and physical examination, but may be aided by urinalysis, and urine cultures should be obtained to determine the responsible bacteria and its antibiotic sensitivity pattern 2.
- Most patients can be treated as outpatients with oral antibiotics and supportive measures, while hospitalization and broad-spectrum intravenous antibiotics should be considered in patients who are systemically ill or have risk factors for antibiotic resistance 2.
Antibiotic Regimens
- Typical antibiotic regimens for acute bacterial prostatitis include:
- Ceftriaxone and doxycycline
- Ciprofloxacin
- Piperacillin/tazobactam 2
- The use of antibiotics, such as ciprofloxacin, before transrectal prostate biopsy can reduce the risk of nosocomial bacterial prostatitis 2.
Chronic Prostatitis Treatment
- Note that the provided evidence for chronic prostatitis treatment 3 may not be directly relevant to the question of acute prostatitis treatment, but it is worth mentioning that treatment of chronic bacterial prostatitis with levofloxacin or ciprofloxacin can lower serum prostate specific antigen (PSA) levels 3.