What is the recommended treatment regimen for acute bacterial prostatitis in a hospital setting?

From the Guidelines

The recommended treatment for acute bacterial prostatitis in a hospital setting typically involves intravenous broad-spectrum antibiotics for 2-4 weeks, followed by oral antibiotics for a total of 4-6 weeks. This approach is based on the most recent and highest quality study available, although it notes that there is insufficient quality of evidence to enable a clear recommendation for the duration of treatment for acute bacterial prostatitis (ABP) or chronic bacterial prostatitis (CBP) 1. Initial empiric therapy often includes a fluoroquinolone (such as ciprofloxacin 400mg IV every 12 hours) or a combination of an aminoglycoside (gentamicin 5mg/kg IV daily) plus ampicillin (2g IV every 6 hours). For patients with severe infection or sepsis, a carbapenem like meropenem (1g IV every 8 hours) may be used.

Key Considerations

• The choice of antibiotic should be guided by local resistance patterns and susceptibility testing when available.
• Supportive measures include adequate hydration, pain management with NSAIDs or opioids as needed, and urinary catheterization only if absolutely necessary due to urinary retention.
• Patients typically require hospitalization until fever resolves and they can tolerate oral medications.
• The optimal durations of treatment for ABP or CBP are unknown and have not been established by high-quality studies, but historical durations range from 14 days for ABP to 6 weeks or longer for CBP 1.

Treatment Approach

• Once clinical improvement occurs, typically after 24-72 hours, therapy can be switched to oral antibiotics based on culture results, with fluoroquinolones (ciprofloxacin 500mg twice daily) or trimethoprim-sulfamethoxazole (160/800mg twice daily) being common choices.
• This aggressive antibiotic approach is necessary because the prostate's blood-tissue barrier limits antibiotic penetration, and untreated infections can progress to abscess formation or sepsis.
• 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)]. 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 recommended treatment regimen for acute bacterial prostatitis in a hospital setting is not explicitly stated in the provided drug labels. However, for chronic bacterial prostatitis, the recommended treatment is levofloxacin 500 mg once daily for 28 days or ciprofloxacin 500 mg twice daily for 28 days.

• Key points:
  • Levofloxacin: 500 mg once daily for 28 days
  • Ciprofloxacin: 500 mg twice daily for 28 days
• Note: The provided information is for chronic bacterial prostatitis, and the treatment regimen for acute bacterial prostatitis may differ. 2 2 3

From the Research

Treatment Regimen for Acute Bacterial Prostatitis

The recommended treatment regimen for acute bacterial prostatitis in a hospital setting includes:

• 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 4
• Typical antibiotic regimens include ceftriaxone and doxycycline, ciprofloxacin, and piperacillin/tazobactam 4
• Treatment of prostatitis should follow evidence-based guidelines, with acute prostatitis being treated with ciprofloxacine 500 mg tid or ofloxacine 200 mg bid or cotrimoxazole 960 mg bid for 4 weeks 5

Antibiotic Treatment

Key points to consider for antibiotic treatment are:

• The minimum duration of antibiotic treatment should be 2-4 weeks 6
• If there is no improvement in symptoms, treatment should be stopped and reconsidered 6
• Fluoroquinolones such as ofloxacin and ciprofloxacin are recommended due to their favorable antibacterial spectrum and pharmacokinetic profile 6
• Ciprofloxacin is concentrated several-fold in ejaculate and seminal fluid but not in prostatic fluid, with concentrations in prostatic fluid exceeding the minimal inhibitory concentration-90% for Enterobacteriaceae but not for Pseudomonas, enterococci, and staphylococci 7

Comparison of Antibiotics

A study comparing lomefloxacin and ciprofloxacin in the treatment of chronic bacterial prostatitis found:

• No statistically significant differences between the results of the two treatment groups 8
• Both lomefloxacin 400 mg once daily and ciprofloxacin 500 mg twice daily for 4 weeks were effective and tolerable treatments for chronic bacterial prostatitis 8