What is the treatment for bacterial prostatitis (inflammation of the prostate gland)?

From the Guidelines

Bacterial prostatitis should be treated with antibiotics, with the specific regimen depending on whether the infection is acute or chronic, and the duration of treatment should be individualized based on clinical response, as there is currently no clear recommendation for the optimal duration of treatment. The treatment for bacterial prostatitis typically involves the use of antibiotics, with fluoroquinolones like ciprofloxacin (500mg twice daily) or levofloxacin (500mg once daily) being commonly prescribed for acute bacterial prostatitis, and a longer course of 4-12 weeks of the same antibiotics for chronic bacterial prostatitis 1. Some key points to consider in the treatment of bacterial prostatitis include:

• Increasing fluid intake to help flush out bacteria
• Avoiding alcohol, caffeine, and spicy foods which can irritate the prostate
• Taking over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours) to manage discomfort
• Considering the addition of alpha-blockers such as tamsulosin (0.4mg daily) to improve urinary symptoms
• Using warm sitz baths to provide additional symptom relief It is essential to note that the optimal durations of treatment for acute and chronic bacterial prostatitis are unknown and have not been established by high-quality studies, and therefore, the treatment should be individualized based on clinical response 1. If symptoms don't improve within 48 hours of starting treatment for acute prostatitis, medical reevaluation is necessary to assess the effectiveness of the treatment and consider alternative options. In terms of diagnosis, acute bacterial prostatitis often presents abruptly with febrile UTI symptoms, while chronic bacterial prostatitis involves more persistent symptoms or recurrent UTIs, and diagnosis involves clinical presentation, laboratory tests, and comparing bacteria levels in prostatic fluid and urinary cultures 1.

From the FDA Drug Label

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 bacterial prostatitis is levofloxacin 500 mg orally once daily for 28 days 2.

• Key points:
  • The treatment duration is 28 days.
  • The dosage is 500 mg once daily.
  • Levofloxacin is the recommended antibiotic for this condition.

From the Research

Treatment Options for Bacterial Prostatitis

• The treatment for bacterial prostatitis typically involves the use of antibiotics, with fluoroquinolones being the preferred agents due to their favorable antibacterial spectrum and pharmacokinetic profile 3, 4, 5, 6, 7.
• For acute bacterial prostatitis, high doses of bactericidal antibiotics are required, while chronic bacterial prostatitis may be treated with a fluoroquinolone for 2-4 weeks 3, 4, 5.
• The minimum duration of antibiotic treatment should be 2-4 weeks, and treatment should not be given for 6-8 weeks without an appraisal of its effectiveness 3.
• In some cases, combination therapy with an α-blocker, an anti-inflammatory, and a muscle relaxant may be used, but this does not appear to offer significant advantages over monotherapy 6.
• Patients who have had multiple unsuccessful treatment regimens may benefit from direct stimulation of the pelvic muscles through electromagnetic or electroacupuncture therapy 6.

Antibiotic Therapy

• Fluoroquinolones such as ciprofloxacin, levofloxacin, and ofloxacin are commonly used to treat bacterial prostatitis 3, 4, 5, 6, 7.
• The oral fluoroquinolones have comparable clinical and microbiological efficacy, as well as adverse effect profiles 7.
• Azithromycin has shown improved eradication rates and clinical cure rates compared to ciprofloxacin in chlamydial prostatitis, with no significant differences regarding adverse effects 7.
• Macrolides have shown higher microbiological and clinical cure rates compared to fluoroquinolones in patients with CBP caused by obligate intracellular pathogens 7.

Treatment Duration

• The optimal treatment duration of fluoroquinolones in the treatment of CBP caused by traditional pathogens is not well established 7.
• Treatment with antibiotics should be continued for at least 2-4 weeks, and may need to be continued for a further 2-4 weeks to achieve clinical cure and eradication of the causative pathogen 3.
• Treatment should not be given for 6-8 weeks without an appraisal of its effectiveness 3.