From the Guidelines
Prostatitis should be treated with antibiotics for 7 to 14 days, depending on the severity of the illness and local resistance patterns, with the goal of reducing morbidity, mortality, and improving quality of life. The diagnosis of prostatitis involves a combination of symptoms, physical examination, and laboratory tests, including digital rectal examination, urine tests, and sometimes expressed prostatic secretions analysis 1. For acute bacterial prostatitis, treatment typically involves antibiotics such as ciprofloxacin 500mg twice daily or trimethoprim-sulfamethoxazole 160/800mg twice daily 1.
Key Considerations
- The optimal duration of treatment for acute bacterial prostatitis (ABP) and chronic bacterial prostatitis (CBP) is unknown and has not been established by high-quality studies 1.
- The microbial spectrum is greater than for uncomplicated UTIs, and antimicrobial resistance is more likely, with E. coli, Proteus spp., Klebsiella spp., Pseudomonas spp., Serratia spp., and Enterococcus spp. being the most common species found in cultures 1.
- Appropriate management of the urological abnormality or the underlying complicating factor is mandatory, and optimal antimicrobial therapy for complicated UTIs depends on the severity of the illness at presentation, as well as local resistance patterns and specific host factors 1.
Treatment Approach
- For chronic bacterial prostatitis, longer antibiotic courses, often 4-12 weeks of the same medications, may be required 1.
- For chronic pelvic pain syndrome (non-bacterial prostatitis), treatment is symptom-focused and may include alpha-blockers, anti-inflammatories, and pelvic floor physical therapy.
- Asymptomatic inflammatory prostatitis typically requires no treatment, and supportive measures for all types include increased fluid intake, warm sitz baths, avoiding irritants, and over-the-counter pain relievers.
Evidence-Based Recommendation
The most recent and highest quality study recommends treatment for 7 to 14 days, depending on the severity of the illness and local resistance patterns 1. This recommendation is based on the European Association of Urology guidelines on urological infections, which provide a comprehensive approach to the diagnosis and treatment of prostatitis.
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)].
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.
Treatment of Prostatitis:
- 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 oral levofloxacin 500 mg once daily.
- Clinical success rates in microbiologically evaluable population 5 to 18 days after completion of therapy were 75% for levofloxacin-treated patients 2 2.
From the Research
Diagnosis of Prostatitis
- The diagnosis of prostatitis is primarily based on history, physical examination, urine culture, and urine specimen testing pre- and post-prostatic massage 3.
- Acute bacterial prostatitis can be diagnosed based on symptoms such as pelvic pain, urinary tract symptoms, and systemic symptoms, as well as physical examination and urinalysis 4.
- Chronic prostatitis/chronic pelvic pain syndrome is often diagnosed based on exclusion of other urologic conditions in association with its presentation 3.
Treatment of Prostatitis
- The mainstay of therapy for prostatitis is an antimicrobial regimen 3.
- For acute bacterial prostatitis, typical antibiotic regimens include ceftriaxone and doxycycline, ciprofloxacin, and piperacillin/tazobactam 4.
- For chronic bacterial prostatitis, levofloxacin has been shown to be effective in eradicating the causative organism and improving symptoms 5, 6, 7.
- Combination therapy with antibacterial agents, alpha-blockers, and Serenoa repens extracts has also been shown to be effective in eradicating the causative organism and improving symptoms in chronic bacterial prostatitis 6.
- Chronic pelvic pain syndrome is a more challenging entity to treat, and commonly used medications include antimicrobials, alpha blockers, and anti-inflammatory agents, but the effectiveness of these agents has not been supported in clinical trials 3.
Treatment Outcomes
- The clinical success rate for levofloxacin in the treatment of chronic bacterial prostatitis has been reported to be around 92% at 5-12 days post treatment, and 61.9% at 6 months post treatment 7.
- The microbiological eradication rate for levofloxacin in the treatment of chronic bacterial prostatitis has been reported to be around 83.7% at 1 month post treatment, and 91.2% at 6 months post treatment 7.
- Combination therapy with antibacterial agents, alpha-blockers, and Serenoa repens extracts has been shown to result in a cumulative eradication rate of 83.9% in chronic bacterial prostatitis 6.