Acute Bacterial Prostatitis Medication

Updated: Jul 20, 2022
  • Author: Samuel G Deem, DO; Chief Editor: Edward David Kim, MD, FACS  more...
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Medication Summary

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.



Class Summary

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

Trimethoprim-sulfamethoxazole (Bactrim DS, Septra DS)

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 (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.


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 (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.

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).