What is the treatment for prostatitis?

From the Guidelines

The treatment for prostatitis should be individualized based on the type and severity of the condition, with a focus on alleviating symptoms and improving quality of life, as there is currently insufficient evidence to provide a clear recommendation for the duration of treatment for either acute or chronic bacterial prostatitis 1.

Key Considerations

• The clinical presentation, diagnostic approach, and treatment for acute and chronic prostatitis are not well-established due to a lack of high-quality evidence 1.
• Acute bacterial prostatitis (ABP) and chronic bacterial prostatitis (CBP) are inflammatory prostate syndromes that require different management approaches 1.
• The optimal durations of treatment for ABP or CBP are unknown and have not been established by high-quality studies, with historical durations ranging from 14 days for ABP to 6 weeks or longer for CBP 1.

Treatment Options

• Antibiotics, such as ciprofloxacin or trimethoprim-sulfamethoxazole, may be prescribed for bacterial prostatitis, but the duration of treatment is uncertain 1.
• For chronic pelvic pain syndrome (non-bacterial prostatitis), treatment may include alpha-blockers, anti-inflammatory medications, and muscle relaxants, as well as supportive measures such as increased fluid intake, warm sitz baths, and pelvic floor physical therapy 1.
• Pain management may include acetaminophen or prescription pain relievers as needed.

Important Notes

• Patients should complete the full course of antibiotics even if symptoms improve and follow up with their healthcare provider to ensure the infection has cleared.
• Urology consultation may be needed for diagnosis and management of prostatitis, particularly for CBP 1.
• Additional prospective studies are needed to determine the appropriate duration of treatment for ABP and CBP 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.

The treatment for chronic bacterial prostatitis is levofloxacin 500 mg taken orally once daily for a total of 28 days 2 2.

• Key points:
  • The treatment is indicated for chronic bacterial prostatitis due to Escherichia coli, Enterococcus faecalis, or methicillin-susceptible Staphylococcus epidermidis.
  • The dosage is 500 mg taken orally once daily.
  • The treatment duration is 28 days.

From the Research

Treatment for Prostatitis

The treatment for prostatitis depends on the type and cause of the condition.

• For acute bacterial prostatitis, treatment typically involves oral antibiotics and supportive measures, with hospitalization and broad-spectrum intravenous antibiotics considered in severe cases 3.
• For chronic bacterial prostatitis, treatment options include levofloxacin 500 mg once daily for 28 days, which has been shown to be as effective as ciprofloxacin 500 mg twice daily for 28 days 4, 5.
• Chronic pelvic pain syndrome, a type of prostatitis, is a more challenging entity to treat, with commonly used medications including antimicrobials, alpha blockers, and anti-inflammatory agents, although their effectiveness has not been supported in clinical trials 6.

Diagnosis and Assessment

Diagnosis of prostatitis is primarily based on history, physical examination, urine culture, and urine specimen testing pre- and post-prostatic massage 6, 7.

• A digital rectal examination should be performed after a midstream urine sample has been collected for urine dipstick, microscopy, and culture 7.
• In acute bacterial prostatitis, the midstream urine sample is the only laboratory investigation required 7.

Types of Prostatitis

There are four classifications of prostatitis:

• Acute bacterial prostatitis
• Chronic bacterial prostatitis
• Chronic prostatitis/chronic pelvic pain syndrome
• Asymptomatic prostatitis 6, 7 Each type has different symptoms and treatment options, and a careful assessment is key to managing the condition effectively 7.