Acute bacterial prostatitis
- Symptoms: fever, rigors, dysuria, frequency, urge incontinence, urgency, pelvic pain
Diagnosis:
- abdominal exam. NB: digital rectal prostate exam is NOT recommended
- urinalysis and urine culture, urine for C. trachomatis and N. gonorrhoeae NAAT
- blood cultures – 25% of cases complicated by bacteremia
- if lack of clinical improvement with culture-guided antibiotic therapy, consider CT to identify structural abnormalities or prostatic abscess +/- urology referral. NB: transrectal US is NOT recommended.
Usual Pathogens
Enterobacterales
Enterococcus spp
P. aeruginosa
Rare:
Staphylococcus spp
Streptococcus spp
Mild-moderate
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Ciprofloxacin | 500-750mg PO bid | 10-14 days |
| or | ||
| TMP/SMX | 1 DS tab PO bid | 2-4 weeks |
| or | ||
| Ceftriaxone | 1-2g IV daily | Switch to oral agent when clinical improvement to complete 10-14 days |
Severe
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Piperacillin-tazobactam | 4.5g IV q6h | Switch to oral agent when clinical improvement to complete 4 weeks |