From the Guidelines
Acute prostatitis typically presents with fever, chills, lower back pain, pelvic discomfort, painful urination, frequent urination, cloudy urine, and sometimes difficulty urinating or urinary retention, and treatment primarily involves antibiotics, typically fluoroquinolones like ciprofloxacin (500mg twice daily) or levofloxacin (500mg once daily) for 2-4 weeks, as recommended by the most recent guidelines 1. The symptoms of acute prostatitis can vary, but common presentations include:
- Fever and chills
- Lower back pain
- Pelvic discomfort
- Painful urination
- Frequent urination
- Cloudy urine
- Difficulty urinating or urinary retention Treatment options for acute prostatitis include:
- Antibiotics, such as fluoroquinolones (ciprofloxacin or levofloxacin) for 2-4 weeks
- Pain management with NSAIDs (ibuprofen) and alpha-blockers (tamsulosin) to relieve urinary symptoms
- Adequate hydration to flush bacteria from the urinary tract
- Stool softeners to reduce pressure on the prostate
- Avoiding irritants such as alcohol, caffeine, and spicy foods According to the European Association of Urology guidelines, Enterobacterales are the primary pathogens in acute bacterial prostatitis (ABP) 1. The optimal duration of treatment for ABP is unknown, but historical durations range from 14 days to 6 weeks or longer 1. It is essential to note that if symptoms do not improve within 48 hours of antibiotic treatment, medical reevaluation is necessary to rule out complications like abscess formation, which may require drainage procedures 1.
From the Research
Symptoms of Acute Prostatitis
- Pelvic pain and urinary tract symptoms, such as dysuria, urinary frequency, and urinary retention 2
- Systemic symptoms, such as fevers, chills, nausea, emesis, and malaise 2
- Acute onset pelvic pain which may or may not be related to voiding, lower urinary tract symptoms, sometimes haematuria or haematospermia and systemic symptoms such as fever and rigors 3
Treatment Options for Acute Prostatitis
- Oral antibiotics and supportive measures for most patients 2
- Hospitalization and broad-spectrum intravenous antibiotics for 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
- Antimicrobial regimen as the mainstay of therapy 4
Diagnosis of Acute 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
- Digital rectal examination to assess for a tender, enlarged, or boggy prostate 2, 3
- Midstream urine (MSU) sample for urine dipstick, microscopy and culture 3
Classification of Prostatitis
- Acute bacterial prostatitis, chronic bacterial prostatitis, chronic pelvic pain syndrome, and asymptomatic inflammatory prostatitis 3, 4
- Chronic pelvic pain syndrome may be multifactorial and part of a more generalised pain disorder 3
Treatment of Chronic Bacterial Prostatitis
- Azithromycin and ciprofloxacin are used in the treatment of chronic prostatitis caused by Chlamydia trachomatis 5
- Levofloxacin is used for NIH Category II Chronic Bacterial Prostatitis, with eradication rates achieved by levofloxacin varying between 71 and 86% 6
- Combination of levofloxacin and azithromycin may be an interesting option in both first-referral and relapsing cases 6