Chronic bacterial prostatitis
(symptoms > 3 months)
- Subacute presentation – may have had prior acute bacterial prostatitis, or recurrent lower UTI symptoms and perineal discomfort.
Diagnosis:
- abdominal exam
- digital rectal prostate exam
- urinalysis and urine culture, urine for C. trachomatis and N. gonorrhoeae NAAT
- if lack of clinical improvement with culture-guided antibiotic therapy, consider transrectal US or CT to identify structural abnormalities, prostate calcifications, or prostatic abscess +/- urology referral.
Usual Pathogens
Enterobacterales
Enterococcus spp
Pseudomonas aeruginosa
Rare:
Staphylococcus spp
Streptococcus spp
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Ciprofloxacin | 500-750mg PO bid | 4 weeks |
| Alternative: | ||
| TMP/SMX | 1 DS tab PO bid | 6 weeks |
| or | ||
| Doxycycline | 100mg PO bid | 6 weeks |
Failure of above agents, e.g. for MRSA, VRE, or ESBL or AmpC-producing E. coli
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Fosfomycin | 3 g PO daily x 1 week followed by 3 g every 2-3 days (depending on tolerance) x 5 weeks | 6 weeks |
| or | ||
| 3 g PO every 2-3 days (depending on tolerance) |