Acute Bacterial Prostatitis Medication
- Author: Samuel G Deem, DO; Chief Editor: Edward David Kim, MD, FACS more...
The goals of pharmacotherapy are to eradicate the infection, reduce morbidity, and prevent complications. Antibiotics are given empirically until results of urine culture and sensitivity become available. Alpha-blocker therapy should also be considered.
Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.
This agent inhibits bacterial growth by inhibiting the synthesis of dihydrofolic acid.
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.
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.
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.
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.
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.
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).
Nickel JC. Inflammatory conditions of the male genitourinary tract: prostatitis and related conditions, orchitis, and epididymitis. Wein. AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: WB Saunders: 2005; Chapter 9.
Nickel JC. 5 alpha reductase therapy for chronic prostatitis. Nickel JC, ed. Textbook of Prostatitis. Oxford, UK: ISIS Medical Media; 1999. 333-7.
Collins MM, Stafford RS, O'Leary MP, Barry MJ. How common is prostatitis? A national survey of physician visits. J Urol. 1998 Apr. 159(4):1224-8. [Medline].
Kanamaru S, Kurazono H, Terai A, Monden K, Kumon H, Mizunoe Y, et al. Increased biofilm formation in Escherichia coli isolated from acute prostatitis. Int J Antimicrob Agents. 2006 Aug. 28 Suppl 1:S21-5. [Medline].
Bergman B. On the relevance of gram-positive bacteria in prostatitis. Infection. 1994. 22 Suppl 1:S22. [Medline].
Williamson DA, Freeman JT, Porter S, Roberts S, Wiles S, Paterson DL, et al. Clinical and molecular correlates of virulence in Escherichia coli causing bloodstream infection following transrectal ultrasound-guided (TRUS) prostate biopsy. J Antimicrob Chemother. 2013 Dec. 68(12):2898-906. [Medline].
Lomberg H, Cedergren B, Leffler H, Nilsson B, Carlström AS, Svanborg-Edén C. Influence of blood group on the availability of receptors for attachment of uropathogenic Escherichia coli. Infect Immun. 1986 Mar. 51(3):919-26. [Medline]. [Full Text].
Wagenlehner FM, Pilatz A, Bschleipfer T, Diemer T, Linn T, Meinhardt A, et al. Bacterial prostatitis. World J Urol. 2013 Mar 22. [Medline].
Nagy V, Kubej D. Acute bacterial prostatitis in humans: current microbiological spectrum, sensitivity to antibiotics and clinical findings. Urologia Internationalis. October/2012. 89 (4):445-450. [Medline].
Nickel JC. The Pre and Post Massage Test (PPMT): a simple screen for prostatitis. Tech Urol. 1997 Spring. 3(1):38-43. [Medline].
Magri V, Cariani L, Bonamore R, Restelli A, Garlaschi MC, Trinchieri A. Microscopic and microbiological findings for evaluation of chronic prostatitis. Arch Ital Urol Androl. 2005 Jun. 77(2):135-8. [Medline].
Meares EM, Stamey TA. Bacteriologic localization patterns in bacterial prostatitis and urethritis. Invest Urol. 1968 Mar. 5(5):492-518. [Medline].
Terrone C, Poggio M, Bollito E, Cracco CM, Scarpa RM. [Asymptomatic prostatitis: a frequent cause of raising PSA]. Recenti Prog Med. 2005 Jul-Aug. 96(7-8):365-9. [Medline].
Granados EA, Riley G, Salvador J, Vincente J. Prostatic abscess: diagnosis and treatment. J Urol. 1992 Jul. 148(1):80-2. [Medline].
Barbalias GA, Nikiforidis G, Liatsikos EN. Alpha-blockers for the treatment of chronic prostatitis in combination with antibiotics. J Urol. 1998 Mar. 159(3):883-7. [Medline].
Aravantinos E, Kalogeras N, Zygoulakis N, Kakkas G, Anagnostou T, Melekos M. Ultrasound-guided transrectal placement of a drainage tube as therapeutic management of patients with prostatic abscess. J Endourol. 2008 Aug. 22(8):1751-4. [Medline].
Chou YH, Tiu CM, Liu JY, Chen JD, Chiou HJ, Chiou SY, et al. Prostatic abscess: transrectal color Doppler ultrasonic diagnosis and minimally invasive therapeutic management. Ultrasound Med Biol. 2004 Jun. 30(6):719-24. [Medline].
Barozzi L, Pavlica P, Menchi I, De Matteis M, Canepari M. Prostatic abscess: diagnosis and treatment. AJR Am J Roentgenol. 1998 Mar. 170(3):753-7. [Medline].
Zowawi HM, Harris PN, Roberts MJ, Tambyah PA, Schembri MA, Pezzani MD, et al. The emerging threat of multidrug-resistant Gram-negative bacteria in urology. Nat Rev Urol. 2015 Oct. 12 (10):570-84. [Medline].
Campeggi A, Ouzaid I, Xylinas E, Lesprit P, Hoznek A, Vordos D, et al. Acute bacterial prostatitis after transrectal ultrasound-guided prostate biopsy: epidemiological, bacteria and treatment patterns from a 4-year prospective study. Int J Urol. 2014 Feb. 21(2):152-5. [Medline].
Song W, Choo SH, Sung HH, Han DH, Jeong BC, Seo SI, et al. Incidence and management of extended-spectrum beta-lactamase and quinolone-resistant Escherichia coli infections after prostate biopsy. Urology. 2014 Nov. 84 (5):1001-7. [Medline].
Wagenlehner FM, Pilatz A, Waliszewski P, Weidner W, Johansen TE. Reducing infection rates after prostate biopsy. Nat Rev Urol. 2014 Feb. 11(2):80-6. [Medline].
Kaye KS, Pogue JM. Infections Caused by Resistant Gram-Negative Bacteria: Epidemiology and Management. Pharmacotherapy. 2015 Oct. 35 (10):949-62. [Medline].
Meares EM Jr. Prostatitis. Med Clin North Am. 1991 Mar. 75(2):405-24. [Medline].
Kabay S, Kabay SC, Yucel M, Ozden H. Efficiency of posterior tibial nerve stimulation in category IIIB chronic prostatitis/chronic pelvic pain: a Sham-Controlled Comparative Study. Urol Int. 2009. 83(1):33-8. [Medline].
Lee SH, Lee BC. Electroacupuncture relieves pain in men with chronic prostatitis/chronic pelvic pain syndrome: three-arm randomized trial. Urology. 2009 May. 73(5):1036-41. [Medline].
Liu L, Yang J. Physician's practice patterns for chronic prostatitis. Andrologia. 2009 Oct. 41(5):270-6. [Medline].
Ludwig M. Diagnosis and therapy of acute prostatitis, epididymitis and orchitis. Andrologia. 2008 Apr. 40(2):76-80. [Medline].
Nickel JC, Shoskes D. Phenotypic approach to the management of chronic prostatitis/chronic pelvic pain syndrome. Curr Urol Rep. 2009 Jul. 10(4):307-12. [Medline].