Prostatitis medical therapy

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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 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

• 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.