Can ceftriaxone be used to treat prostatitis?

From the Guidelines

Ceftriaxone can be used to treat prostatitis, particularly in cases of acute bacterial prostatitis caused by susceptible organisms, as recommended by the Infectious Diseases Society of America & European Society for Microbiology and Infectious Diseases guideline from 2011 [@359@]. The typical dosage is 1-2 grams intravenously or intramuscularly once daily for 2-4 weeks, depending on the severity of the infection and clinical response. Some key points to consider when using ceftriaxone for prostatitis include:

• Ceftriaxone is often used as initial therapy, especially for hospitalized patients with severe symptoms, and may be followed by oral antibiotics to complete the treatment course.
• This third-generation cephalosporin is effective against many gram-negative bacteria including Escherichia coli, which is the most common cause of bacterial prostatitis.
• It also has activity against some gram-positive organisms.
• Ceftriaxone achieves good penetration into prostatic tissue, especially during acute inflammation when the blood-prostate barrier is compromised. However, for chronic prostatitis, other antibiotics with better prostatic penetration like fluoroquinolones or trimethoprim-sulfamethoxazole may be preferred for longer-term therapy, as noted in the guideline from the Infectious Diseases Society of America & European Society for Microbiology and Infectious Diseases [@359@]. Treatment should be guided by culture results when available to ensure the causative organism is susceptible to ceftriaxone, and local resistance patterns should be considered, as recommended by the European Association of Urology & European Society for Paediatric Urology guideline from 2015 [@356@].

From the Research

Ceftriaxone for Prostatitis Treatment

• Ceftriaxone can be considered an appropriate treatment for chronic bacterial prostatitis, as shown in a case series where 11 men with chronic bacterial prostatitis were treated with once-daily ceftriaxone intravenously for 6 weeks, resulting in 9 patients being clinically cured at 3 months follow-up 1.
• The use of ceftriaxone in prostatic infection is supported by its prostate pharmacokinetics, which allows it to penetrate the prostate tissue effectively 1.

Limitations of Ceftriaxone in Prostatitis Treatment

• However, it is noted that penicillins, cephalosporins, and aminoglycosides, including ceftriaxone, do not penetrate well into the chronically inflamed prostate tissue, making them less effective for chronic prostatitis treatment 2.
• The preferred agents for treating chronic prostatitis are trimethoprim or doxycycline, with doxycycline being active against chlamydia and other common organisms responsible for chronic prostatitis 2.

Ceftriaxone's Antibacterial Activity and Pharmacological Properties

• Ceftriaxone has a broad spectrum of activity against Gram-positive and Gram-negative aerobic, and some anaerobic, bacteria, making it effective against various types of infections, including urinary tract infections 3.
• Ceftriaxone's long half-life allows for once-daily administration, which can result in convenience and cost benefits, especially for the treatment of serious infections due to multidrug-resistant Gram-negative bacteria 3.

Immune Response and Chronic Prostatitis

• The immune response to prostate infection is incompletely understood, and chronic prostatitis may develop despite strong innate immune responses, possibly due to a failure to develop immune memory to infection 4.
• Further research is needed to understand the immune response to prostate infection and to develop non-antibiotic-based approaches to treat chronic prostatitis 4.