Acute Bacterial Prostatitis Medication

  • Author: Samuel G Deem, DO; Chief Editor: Edward David Kim, MD, FACS   more...
 
Updated: Dec 15, 2011
 

Medication Summary

The goals of pharmacotherapy are to eradicate the infection, reduce morbidity, and prevent complications.

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Antibiotics

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

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Trimethoprim-sulfamethoxazole (Bactrim DS, Septra DS)

 

This agent inhibits bacterial growth by inhibiting the synthesis of dihydrofolic acid.

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Gentamicin

 

Gentamicin is an aminoglycoside antibiotic for gram-negative coverage, including pseudomonal species. It is synergistic with beta-lactamase against enterococci. It interferes with bacterial protein synthesis by binding to the 30S and 50S ribosomal subunits.

Dosing regimens are numerous and are adjusted based on creatine clearance and changes in the volume of distribution, as well as body space into which the agent needs to distribute. Gentamicin may be given IV or IM. Each regimen must be followed by at least a trough level drawn on the third or fourth dose, 0.5 hour before dosing; the peak level may be drawn 0.5 hour after the 30-min infusion.

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Ampicillin

 

Ampicillin is a broad-spectrum penicillin. It interferes with bacterial cell wall synthesis during active replication, causing bactericidal activity against susceptible organisms. It is an alternative to amoxicillin when the patient is unable to take medication orally.

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Levofloxacin (Levaquin)

 

Levofloxacin is indicated for chronic bacterial prostatitis due to E coli, E faecalis, or S epidermidis. It is a second-generation quinolone that acts by interfering with DNA gyrase in bacterial cells.

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Ofloxacin

 

Ofloxacin penetrates the prostate well and is effective against N gonorrhea and C trachomatis. It is a pyridine carboxylic acid derivative with a broad spectrum of bactericidal effect.

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Norfloxacin (Noroxin)

 

Norfloxacin is a fluoroquinolone with activity against pseudomonads, streptococci, MRSA, S epidermidis, and most gram-negative organisms, but it has no activity against anaerobes. It inhibits bacterial DNA synthesis and, consequently, growth.

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Clindamycin (Cleocin)

 

Clindamycin is a semisynthetic antibiotic produced by a 7(S)-chloro-substitution of 7(R)-hydroxyl group of the parent compound lincomycin. It inhibits bacterial growth, possibly by blocking the dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. It widely distributes in the body, without penetration of the CNS. Clindamycin is protein bound and excreted by the liver and kidneys.

It is effective against gram-positive aerobic and anaerobic bacteria (except enterococci).

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Contributor Information and Disclosures
Author

Samuel G Deem, DO  Faculty in Urology, Institutional Scientific Review Board, Charleston Area Medical Center

Samuel G Deem, DO is a member of the following medical societies: American College of Osteopathic Surgeons, American College of Surgeons, American Osteopathic Association, American Society of Clinical Oncology, American Urological Association, Endourological Society, and Society of Urologic Oncology

Disclosure: Nothing to disclose.

Coauthor(s)

Jonathan J Rhee, MD  Staff Physician, Department of Urology, University of Virginia School of Medicine

Jonathan J Rhee, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Michael Piesman, MD  Staff Physician, Department of Internal Medicine, Madigan Army Medical Center

Michael Piesman, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Raymond A Costabile, MD  Jay Y Gillenwater Professor of Urology and Vice Chairman, Senior Associate Dean for Clinical Strategy, University of Virginia Health System

Raymond A Costabile, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society of Andrology, American Urological Association, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS  Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, Sexual Medicine Society of North America, and Tennessee Medical Association

Disclosure: Lilly Consulting fee Advisor; Astellas Consulting fee Speaking and teaching; Watson Consulting fee Speaking and teaching; Allergan Consulting fee Speaking and teaching

Additional Contributors

Edmund S Sabanegh Jr, MD Chairman, Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation

Edmund S Sabanegh Jr, MD is a member of the following medical societies: American Medical Association, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, Society for the Study of Male Reproduction, Society of Reproductive Surgeons, and Southwest Oncology Group

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

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