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:
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Ceftriaxone 1-2 g q12-24h with or without gentamicin 1.7 mg/kg IV q8h or
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Cefotaxime 2 g IV q4-8h with or without gentamicin 1.7 mg/kg IV q8h or
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Ciprofloxacin 500 mg IV q12h with or without gentamicin 1.7 mg/kg IV q8h or
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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:
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Ciprofloxacin 500 mg PO BID for 28 days or
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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:
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Empiric treatment is not recommended
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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
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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
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Uncommon organisms, such as Chlamydia, Mycobacterium tuberculosis, Coccidioides, Histoplasma, and Candida, must be considered if routine cultures are negative [11]
