Prostatitis Empiric Therapy

Updated: Apr 16, 2018
  • Author: Vikas Goswamy, MD; Chief Editor: Thomas E Herchline, MD  more...
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Empiric Therapy Regimens

Empiric therapeutic regimens for prostatitis are outlined below, including those for acute prostatitis and chronic prostatitis.

Inpatient therapy for acute prostatitis: acutely ill and/or suspected sepsis

See the list below:

  • Ceftriaxone 1-2 g q12-24h with or without gentamicin 1.7 mg/kg IV q8h or

  • Cefotaxime 2 g IV q4-8h with or without gentamicin 1.7 mg/kg IV q8h or

  • Ciprofloxacin 500 mg IV q12h with or without gentamicin 1.7 mg/kg IV q8h or

  • Levofloxacin 500 mg IV daily with or without gentamicin 1.7 mg/kg IV q8h

After initial improvement with parenteral antibiotics, acute bacterial prostatitis may be managed with outpatient care to complete a 4-week course of oral antibiotics with urologic follow-up.{ref1-INVALID REFERENCE} [1, 2, 3, 4, 5, 6, 7] Therapy can be tailored based on previous cultures. [8]

Outpatient therapy for acute prostatitis

See the list below:

  • Ciprofloxacin 500 mg PO BID for 28 days or

  • Levofloxacin 500 mg PO daily for 28 days [4, 8] or

  • Trimethoprim/sulfamethoxazole (TMP/SMX) 1 DS tablet PO BID for 28 days

If gonorrhea is suspected (sexually active, age < 35 years), give ceftriaxone 250 mg IV as a single dose in addition to above; gonorrhea resistant to quinolones has been widely reported.{ref1-INVALID REFERENCE} [1, 2, 9, 10]

Chronic bacterial prostatitis (CBP)

See the list below:

  • Empiric treatment is not recommended

  • Symptoms of CBP are nonspecific; patients with symptoms suggestive of CBP should be evaluated with a Meares-Stamey test (see below) or pre- and post-prostatic massage urine samples

  • The Meares-Stamey test consists of the sequential collection of urine and expressed prostatic secretions; CBP is confirmed if the bacterial counts in the prostatic secretions and the first 10 mL of urine post-prostatic massage are at least 10 times the colony count of the initial 10 mL of voided urine

  • Uncommon organisms, such as Chlamydia, Mycobacterium tuberculosis, Coccidioides, Histoplasma, and Candida, must be considered if routine cultures are negative [11]