What antibiotic is used to treat acute bacterial prostatitis?

Antibiotic Treatment for Acute Bacterial Prostatitis

For mild-to-moderate acute bacterial prostatitis, start with oral ciprofloxacin 500-750 mg twice daily for 2-4 weeks, provided local fluoroquinolone resistance is less than 10%. 1, 2

Severity-Based Treatment Algorithm

Mild-to-Moderate Cases (Outpatient)

• Ciprofloxacin is the first-line oral agent at 500-750 mg twice daily for 2-4 weeks, achieving 92-97% success rates 1, 2
• Levofloxacin 750 mg once daily is an alternative fluoroquinolone option 3, 4
• Avoid amoxicillin or ampicillin empirically due to very high worldwide resistance rates 3, 1

Severe Cases or Hospitalized Patients

When patients present with systemic illness (fever, chills, inability to urinate, or inability to tolerate oral intake), initiate intravenous therapy 2, 5:

First-line IV options:

• Ceftriaxone 1-2 g once daily 1, 2
• Cefotaxime 2 g three times daily 1
• Piperacillin-tazobactam 2.5-4.5 g three times daily 2, 5
• Ciprofloxacin 400 mg twice daily IV (can transition to oral once improved) 3

Second-line IV option:

• Amikacin 15 mg/kg once daily 1

Critical Treatment Considerations

Duration and Monitoring

• Assess clinical response after 48-72 hours and adjust antibiotics based on culture results 3
• Complete a total of 2-4 weeks of antibiotic therapy to prevent progression to chronic bacterial prostatitis 3, 2
• Do not stop antibiotics prematurely, as this can lead to chronic bacterial prostatitis 3

Antibiotic Selection Pitfalls

• Only use fluoroquinolones empirically if local resistance is <10% 3, 1
• For patients with risk factors for antibiotic resistance or healthcare-associated infections, consider broader-spectrum options initially 3
• Local resistance patterns should always guide final antibiotic selection 3

Diagnostic Requirements Before Treatment

Essential Tests

• Obtain midstream urine culture to identify causative organisms (typically E. coli, Klebsiella, Pseudomonas in 80-97% of cases) 3, 2
• Collect blood cultures in febrile patients 3
• Complete blood count to assess for leukocytosis 3

Physical Examination Caution

• Avoid vigorous prostatic massage or digital rectal examination in acute prostatitis due to risk of bacteremia 3
• Perform only gentle digital rectal examination to assess for tender, enlarged, or boggy prostate 3, 5

Transition Strategy

• Switch from IV to oral antibiotics once clinically improved (typically after 48-72 hours of IV therapy) 3
• Continue oral therapy to complete the full 2-4 week course 3, 2