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__NOTOC__ | __NOTOC__ | ||
{{Prostatitis}} | {{Prostatitis}} | ||
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{{CMG}} | |||
==Treatment== | |||
===Antimicrobial regimen=== | |||
====Acute Bacterial Prostatitis==== | |||
*1. '''Uncomplicated (with low risk of STD pathogens)'''<ref name="pmid20459324">{{cite journal| author=Lipsky BA, Byren I, Hoey CT| title=Treatment of bacterial prostatitis. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 12 | pages= 1641-52 | pmid=20459324 | doi=10.1086/652861 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20459324 }} </ref> | |||
:*1.1''' ''Enterobacteriaceae'' (especially ''Escherichia coli'')''' | |||
::* Preferred regimen: [[Ciprofloxacin]] 400 mg IV or 500 mg PO bid {{or}} [[Levofloxacin]] 500–750 mg IV/PO qd | |||
::* Alternative regimen: [[TMP-SMX]] DS (160 mg TMP) bid | |||
::* Note: 2 weeks duration of therapy may be sufficient; if patient remains symptomatic, extend to 4 weeks | |||
:*1.2''' ''Enterococcus species'' ''' | |||
::* Preferred regimen: [[Ampicillin]] 1–2 g IV q4h {{or}} [[Vancomycin]] 15 mg/kg q12h | |||
::* Alternative regimen: [[Levofloxacin]] 750 PO qd {{or}} [[Linezolid]] 600 mg q12h | |||
::* Note: Use intravenous therapy if systemically ill; switch to oral therapy when stable | |||
:*1.3''' ''Pseudomonas aeruginosa'' ''' | |||
::* Preferred regimen: [[Ciprofloxacin]] 400 mg tid | |||
::* Alternative regimen: [[Piperacillin-tazobactam]] 4.5 g IV q6h | |||
*2. '''Uncomplicated (with risk of STD pathogens)''' | |||
:*2.1''' ''Neisseria gonorrhoeae'' or ''Chlamydia trachomatis'' ''' | |||
::* Preferred regimen: [[Ceftriaxone]] 250 mg IM {{or}} [[Cefixime]] 400 mg PO single dose {{and}} [[Doxycycline]] 100 mg PO bid {{or}} [[Azithromycin]] 500 mg PO qd | |||
::* Alternative regimen: Fluoroquinolones not recommended for gonococcal infection | |||
::* Note: Treat for 2 weeks in most cases. Obtain urine nucleicacid amplification test for ''N.gonorrhoeae'' and ''C.trachomatis'' | |||
*3 '''Uncomplicated, with risk of antibiotic resistant pathogen''' | |||
:*3.1 '''Fluoroquinolone-resistant ''Enterobacteriaceae'' ''' | |||
::* Preferred regimen: [[Ertapenem]] 1 g IV qd | |||
::* Alternative regimen: [[Ceftriaxone]] 1 g IV qd or [[Imipenem]] 500mg IV q6h {{or}} [[Tigecycline]] 100 mg IV x 1 dose then 50 mg IV q12h | |||
:*3.2 '''ES or AmpC beta lactamase producing ''Enterobacteriaceae'' ''' | |||
::* Preferred regimen: [[Ertapenem]] 1 g IV qd | |||
::* Alternative regimen: [[Cefepime]] 2g IV q12h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Tigecycline]] 100 mg IV single dose then 50 mg IV q12h | |||
:*3.3 '''Fluoroquinolone-resistant ''pseudomonas'' ''' | |||
::* Preferred regimen: [[Imipenem]] 500 mg IV q6h | |||
::* Alternative regimen: [[Meropenem]] 500 mg IV q8h | |||
*4. '''Complicated by bacteremia or suspected prostatic abscess''' | |||
:*4.1''' ''Enterobacteriaceae'' or ''Enterococcus'' species ''' | |||
::* Preferred regimen: [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Levofloxacin]] 500 mg IV q24h | |||
::* Alternative regimen: [[Ceftriaxone]] 1–2 g IV q24h {{and}} [[Levofloxacin]] 500–750 mg PO qd {{or}} [[Ertapenem]] 1 g IV q24h {{or}} piperacillin-tazobactam 3.375 g IV q6h | |||
::* Note: Treat for 4 weeks. Obtain blood cultures; Consider genitourinary imaging; Change IV to PO regimen when blood cultures are sterile and abscess drained. | |||
====Chronic Bacterial Prostatitis==== | |||
* '''Chronic Bacterial Prostatitis'''<ref name="pmid15364307">{{cite journal| author=Schaeffer AJ, National Institute of Diabetes and Digestive and Kidney Diseases of the US National Institutes of Health| title=NIDDK-sponsored chronic prostatitis collaborative research network (CPCRN) 5-year data and treatment guidelines for bacterial prostatitis. | journal=Int J Antimicrob Agents | year= 2004 | volume= 24 Suppl 1 | issue= | pages= S49-52 | pmid=15364307 | doi=10.1016/j.ijantimicag.2004.02.009 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15364307 }} </ref> <ref name="pmid20459324">{{cite journal| author=Lipsky BA, Byren I, Hoey CT| title=Treatment of bacterial prostatitis. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 12 | pages= 1641-52 | pmid=20459324 | doi=10.1086/652861 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20459324 }} </ref> | |||
:*1.''' ''Enterobacteriaceae'' (Enterococcus species) ''' | |||
::* Preferred regimen: [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Levofloxacin]] 500 mg IV q24h | |||
::* Alternative regimen: [[TMP-SMX]] single dose DS bid | |||
:*2.''' ''Staphylococcus species'' ''' | |||
::* Preferred regimen: [[Azithromycin]] 500 mg PO qd | |||
::* Alternative regimen: [[Doxycycline]] 100 mg PO bid | |||
:* Note: Duration of therapy 4–6 weeks; Consider suppressive therapy if relapses occur. | |||
==References== | ==References== | ||
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[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
[[Category:Infectious Disease Project]] | |||
Revision as of 13:25, 13 August 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Treatment
Antimicrobial regimen
Acute Bacterial Prostatitis
- 1. Uncomplicated (with low risk of STD pathogens)[1]
- 1.1 Enterobacteriaceae (especially Escherichia coli)
- Preferred regimen: Ciprofloxacin 400 mg IV or 500 mg PO bid OR Levofloxacin 500–750 mg IV/PO qd
- Alternative regimen: TMP-SMX DS (160 mg TMP) bid
- Note: 2 weeks duration of therapy may be sufficient; if patient remains symptomatic, extend to 4 weeks
- 1.2 Enterococcus species
- Preferred regimen: Ampicillin 1–2 g IV q4h OR Vancomycin 15 mg/kg q12h
- Alternative regimen: Levofloxacin 750 PO qd OR Linezolid 600 mg q12h
- Note: Use intravenous therapy if systemically ill; switch to oral therapy when stable
- 1.3 Pseudomonas aeruginosa
- Preferred regimen: Ciprofloxacin 400 mg tid
- Alternative regimen: Piperacillin-tazobactam 4.5 g IV q6h
- 2. Uncomplicated (with risk of STD pathogens)
- 2.1 Neisseria gonorrhoeae or Chlamydia trachomatis
- Preferred regimen: Ceftriaxone 250 mg IM OR Cefixime 400 mg PO single dose AND Doxycycline 100 mg PO bid OR Azithromycin 500 mg PO qd
- Alternative regimen: Fluoroquinolones not recommended for gonococcal infection
- Note: Treat for 2 weeks in most cases. Obtain urine nucleicacid amplification test for N.gonorrhoeae and C.trachomatis
- 3 Uncomplicated, with risk of antibiotic resistant pathogen
- 3.1 Fluoroquinolone-resistant Enterobacteriaceae
- Preferred regimen: Ertapenem 1 g IV qd
- Alternative regimen: Ceftriaxone 1 g IV qd or Imipenem 500mg IV q6h OR Tigecycline 100 mg IV x 1 dose then 50 mg IV q12h
- 3.2 ES or AmpC beta lactamase producing Enterobacteriaceae
- Preferred regimen: Ertapenem 1 g IV qd
- Alternative regimen: Cefepime 2g IV q12h OR Imipenem 500 mg IV q6h OR Tigecycline 100 mg IV single dose then 50 mg IV q12h
- 3.3 Fluoroquinolone-resistant pseudomonas
- 4. Complicated by bacteremia or suspected prostatic abscess
- 4.1 Enterobacteriaceae or Enterococcus species
- Preferred regimen: Ciprofloxacin 400 mg IV q12h OR Levofloxacin 500 mg IV q24h
- Alternative regimen: Ceftriaxone 1–2 g IV q24h AND Levofloxacin 500–750 mg PO qd OR Ertapenem 1 g IV q24h OR piperacillin-tazobactam 3.375 g IV q6h
- Note: Treat for 4 weeks. Obtain blood cultures; Consider genitourinary imaging; Change IV to PO regimen when blood cultures are sterile and abscess drained.
Chronic Bacterial Prostatitis
- 1. Enterobacteriaceae (Enterococcus species)
- Preferred regimen: Ciprofloxacin 400 mg IV q12h OR Levofloxacin 500 mg IV q24h
- Alternative regimen: TMP-SMX single dose DS bid
- 2. Staphylococcus species
- Preferred regimen: Azithromycin 500 mg PO qd
- Alternative regimen: Doxycycline 100 mg PO bid
- Note: Duration of therapy 4–6 weeks; Consider suppressive therapy if relapses occur.
References
- ↑ 1.0 1.1 Lipsky BA, Byren I, Hoey CT (2010). "Treatment of bacterial prostatitis". Clin Infect Dis. 50 (12): 1641–52. doi:10.1086/652861. PMID 20459324.
- ↑ Schaeffer AJ, National Institute of Diabetes and Digestive and Kidney Diseases of the US National Institutes of Health (2004). "NIDDK-sponsored chronic prostatitis collaborative research network (CPCRN) 5-year data and treatment guidelines for bacterial prostatitis". Int J Antimicrob Agents. 24 Suppl 1: S49–52. doi:10.1016/j.ijantimicag.2004.02.009. PMID 15364307.