Prostatitis Empiric Therapy
Updated: Apr 16, 2018
Author: Vikas Goswamy, MD; Chief Editor: Thomas E Herchline, MD
Empiric therapeutic regimens for prostatitis are outlined below, including those for acute prostatitis and chronic prostatitis.
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]
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]
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]