Chronic Bacterial Prostatitis Guidelines

1. Nickel CJ. Inflammatory and Pain conditions of the Male Genitourinary Tract: Prostatitis and Related Pain Conditions, Orchitis, and Epididymitis. Campbell-Walsh Urology. 11th ed. Elsevier; 2016.

2. McNaughton Collins M, Fowler FJ Jr, Elliott DB, Albertsen PC, Barry MJ. Diagnosing and treating chronic prostatitis: do urologists use the four-glass test?. Urology. 2000 Mar. 55 (3):403-7. [QxMD MEDLINE Link].

3. Nickel JC. The Pre and Post Massage Test (PPMT): a simple screen for prostatitis. Tech Urol. 1997 Spring. 3 (1):38-43. [QxMD MEDLINE Link].

4. Nickel JC. Rational management of nonbacterial prostatitis and prostatodynia. Curr Opin Urol. 1996. 6:53-58.

5. Meares EM, Stamey TA. Bacteriologic localization patterns in bacterial prostatitis and urethritis. Invest Urol. 1968 Mar. 5(5):492-518. [QxMD MEDLINE Link].

6. Drach GW, Fair WR, Meares EM, Stamey TA. Classification of benign diseases associated with prostatic pain: prostatitis or prostatodynia?. J Urol. 1978 Aug. 120 (2):266. [QxMD MEDLINE Link].

7. Nickel JC, Nyberg LM, Hennenfent M. Research guidelines for chronic prostatitis: consensus report from the first National Institutes of Health International Prostatitis Collaborative Network. Urology. 1999 Aug. 54 (2):229-33. [QxMD MEDLINE Link].

8. Bowen DK, Dielubanza E, Schaeffer AJ. Chronic bacterial prostatitis and chronic pelvic pain syndrome. BMJ Clin Evid. 2015 Aug 27. 2015:1690-8. [QxMD MEDLINE Link]. [Full Text].

9. Weidner W, Schiefer HG, Krauss H, Jantos C, Friedrich HJ, Altmannsberger M. Chronic prostatitis: a thorough search for etiologically involved microorganisms in 1,461 patients. Infection. 1991. 19 Suppl 3:S119-25. [QxMD MEDLINE Link].

10. Schneider H, Ludwig M, Hossain HM, Diemer T, Weidner W. The 2001 Giessen Cohort Study on patients with prostatitis syndrome--an evaluation of inflammatory status and search for microorganisms 10 years after a first analysis. Andrologia. 2003 Oct. 35 (5):258-62. [QxMD MEDLINE Link].

11. Krieger JN, Ross SO, Limaye AP, Riley DE. Inconsistent localization of gram-positive bacteria to prostate-specific specimens from patients with chronic prostatitis. Urology. 2005 Oct. 66 (4):721-5. [QxMD MEDLINE Link].

12. Weidner W, Diemer T, Huwe P, Rainer H, Ludwig M. The role of Chlamydia trachomatis in prostatitis. Int J Antimicrob Agents. 2002 Jun. 19(6):466-70. [QxMD MEDLINE Link].

13. Nickel JC, Costerton JW, McLean RJ, Olson M. Bacterial biofilms: influence on the pathogenesis, diagnosis and treatment of urinary tract infections. J Antimicrob Chemother. 1994 May. 33 Suppl A:31-41. [QxMD MEDLINE Link].

14. Pontari MA. Etiology of chronic prostatitis/chronic pelvic pain syndrome: psychoimmunoneurendocrine dysfunction (PINE syndrome) or just a really bad infection?. World J Urol. 2013 Apr 12. [QxMD MEDLINE Link].

15. Ludwig M, Weidner W, Schroeder-Printzen I, Zimmermann O, Ringert RH. Transrectal prostatic sonography as a useful diagnostic means for patients with chronic prostatitis or prostatodynia. Br J Urol. 1994 Jun. 73 (6):664-8. [QxMD MEDLINE Link].

16. Oh MM, Chae JY, Kim JW, Kim JW, Yoon CY, Park MG, et al. Positive culture for extended-spectrum β-lactamase during acute prostatitis after prostate biopsy is a risk factor for progression to chronic prostatitis. Urology. 2013 Jun. 81 (6):1209-12. [QxMD MEDLINE Link].

17. Wiygul RD. Prostatitis: epidemiology of inflammation. Curr Urol Rep. 2005 Jul. 6(4):282-9. [QxMD MEDLINE Link].

18. Habermacher GM, Chason JT, Schaeffer AJ. Prostatitis/chronic pelvic pain syndrome. Annu Rev Med. 2006. 57:195-206. [QxMD MEDLINE Link].

19. Krieger JN, Egan KJ. Comprehensive evaluation and treatment of 75 men referred to chronic prostatitis clinic. Urology. 1991 Jul. 38 (1):11-9. [QxMD MEDLINE Link].

20. Schaeffer AJ, Wendel EF, Dunn JK, Grayhack JT. Prevalence and significance of prostatic inflammation. J Urol. 1981 Feb. 125 (2):215-9. [QxMD MEDLINE Link].

21. McNaughton Collins M, Pontari MA, O'Leary MP, Calhoun EA, Santanna J, Landis JR, et al. Quality of life is impaired in men with chronic prostatitis: the Chronic Prostatitis Collaborative Research Network. J Gen Intern Med. Oct/2001. 16(10):656-62. [QxMD MEDLINE Link].

22. Magri V, Perletti G, Montanari E, Marras E, Chiaffarino F, Parazzini F. Chronic prostatitis and erectile dysfunction: results from a cross-sectional study. Arch Ital Urol Androl. 2008 Dec. 80(4):172-5. [QxMD MEDLINE Link].

23. Cai T, Pisano F, Magri V, Verze P, Mondaini N, D'Elia C, et al. Chlamydia trachomatis Infection Is Related to Premature Ejaculation in Chronic Prostatitis Patients: Results from a Cross-Sectional Study. J Sex Med. 2014 Sep 25. [QxMD MEDLINE Link].

24. Alkan I, Yüksel M, Özveri H, Atalay A, Canat HL, Culha MG, et al. Semen reactive oxygen species levels are correlated with erectile function among chronic prostatitis/chronic pelvic pain syndrome patients. Int J Impot Res. 2018 Aug 1. [QxMD MEDLINE Link].

25. Vicari LO, Castiglione R, Salemi M, Vicari BO, Mazzarino MC, Vicari E. Effect of levofloxacin treatment on semen hyperviscosity in chronic bacterial prostatitis patients. Andrologia. 2015 Aug 10. [QxMD MEDLINE Link].

26. Rybicki BA, Kryvenko ON, Wang Y, Jankowski M, Trudeau S, Chitale DA, et al. Racial differences in the relationship between clinical prostatitis, presence of inflammation in benign prostate and subsequent risk of prostate cancer. Prostate Cancer Prostatic Dis. 2016 Jun. 19 (2):145-50. [QxMD MEDLINE Link].

27. [Guideline] Rees J, Abrahams M, Doble A, Cooper A, Prostatitis Expert Reference Group (PERG). Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline. BJU Int. 2015 Oct. 116 (4):509-25. [QxMD MEDLINE Link]. [Full Text].

28. Turner JA, Ciol MA, Von Korff M, Berger R. Validity and responsiveness of the national institutes of health chronic prostatitis symptom index. J Urol. 2003 Feb. 169 (2):580-3. [QxMD MEDLINE Link].

29. Propert KJ, Litwin MS, Wang Y, Alexander RB, Calhoun E, Nickel JC, et al. Responsiveness of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). Qual Life Res. 2006 Mar. 15 (2):299-305. [QxMD MEDLINE Link].

30. Shoskes DA, Nickel JC, Kattan MW. Phenotypically directed multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome: a prospective study using UPOINT. Urology. 2010 Jun. 75 (6):1249-53. [QxMD MEDLINE Link].

31. Budía A, Luis Palmero J, Broseta E, Tejadillos S, Benedicto A, Queipo JA, et al. Value of semen culture in the diagnosis of chronic bacterial prostatitis: a simplified method. Scand J Urol Nephrol. 2006. 40(4):326-31. [QxMD MEDLINE Link].

32. Zegarra Montes LZ, Sanchez Mejia AA, Loza Munarriz CA, Gutierrez EC. Semen and urine culture in the diagnosis of chronic bacterial prostatitis. Int Braz J Urol. 2008 Jan-Feb. 34 (1):30-7, discussion 38-40. [QxMD MEDLINE Link].

33. Budía A, Luis Palmero J, Broseta E, Tejadillos S, Benedicto A, Queipo JA, et al. Value of semen culture in the diagnosis of chronic bacterial prostatitis: a simplified method. Scand J Urol Nephrol. 2006. 40 (4):326-31. [QxMD MEDLINE Link].

34. Magri V, Wagenlehner FM, Montanari E, Marras E, Orlandi V, Restelli A, et al. Semen analysis in chronic bacterial prostatitis: diagnostic and therapeutic implications. Asian J Androl. 2009 Jul. 11(4):461-77. [QxMD MEDLINE Link].

35. Magri V, Trinchieri A, Ceriani I, Marras E, Perletti G. Eradication of unusual pathogens by combination pharmacological therapy is paralleled by improvement of signs and symptoms of chronic prostatitis syndrome. Arch Ital Urol Androl. 2007 Jun. 79 (2):93-8. [QxMD MEDLINE Link].

36. Nickel JC, Xiang J. Clinical significance of nontraditional bacterial uropathogens in the management of chronic prostatitis. J Urol. 2008 Apr. 179 (4):1391-5. [QxMD MEDLINE Link].

37. Gill BC, Shoskes DA. Bacterial prostatitis. Curr Opin Infect Dis. 2016 Feb. 29 (1):86-91. [QxMD MEDLINE Link].

38. Herati AS, Moldwin RM. Alternative therapies in the management of chronic prostatitis/chronic pelvic pain syndrome. World J Urol. 2013 Jun 6. [QxMD MEDLINE Link].

39. Franco JVA, Turk T, Jung JH, Xiao YT, Iakhno S, Garrote V, et al. Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome: a Cochrane systematic review. BJU Int. 2018 Jul 18. [QxMD MEDLINE Link].

40. Anderson RU, Wise D, Nathanson BH. Chronic Prostatitis/Chronic Pelvic Pain as a Psycho-Neuromuscular Disorder-A Meta-analysis. Urology. 2018 Jul 27. [QxMD MEDLINE Link].

41. Bundrick W, Heron SP, Ray P, Schiff WM, Tennenberg AM, Wiesinger BA, et al. Levofloxacin versus ciprofloxacin in the treatment of chronic bacterial prostatitis: a randomized double-blind multicenter study. Urology. 2003 Sep. 62 (3):537-41. [QxMD MEDLINE Link].

42. Zhang ZC, Jin FS, Liu DM, Shen ZJ, Sun YH, Guo YL. Safety and efficacy of levofloxacin versus ciprofloxacin for the treatment of chronic bacterial prostatitis in Chinese patients. Asian J Androl. 2012 Nov. 14 (6):870-4. [QxMD MEDLINE Link].

43. Perletti G, Marras E, Wagenlehner FM, Magri V. Antimicrobial therapy for chronic bacterial prostatitis. Cochrane Database Syst Rev. 2013 Aug 12. CD009071. [QxMD MEDLINE Link].

44. Dalhoff A. Global fluoroquinolone resistance epidemiology and implictions for clinical use. Interdiscip Perspect Infect Dis. 2012. 2012:976273. [QxMD MEDLINE Link].

45. Sarma JB, Marshall B, Cleeve V, Tate D, Oswald T, Woolfrey S. Effects of fluoroquinolone restriction (from 2007 to 2012) on resistance in Enterobacteriaceae: interrupted time-series analysis. J Hosp Infect. 2015 Sep. 91 (1):68-73. [QxMD MEDLINE Link].

46. Trinchieri A, Abdelrahman KM, Bhatti KH, Bello JO, Das K, Gatsev O, et al. Spectrum of Causative Pathogens and Resistance Rates to Antibacterial Agents in Bacterial Prostatitis. Diagnostics (Basel). 2021 Jul 25. 11 (8):[QxMD MEDLINE Link]. [Full Text].

47. Grayson ML, Macesic N, Trevillyan J, Ellis AG, Zeglinski PT, Hewitt NH, et al. Fosfomycin for Treatment of Prostatitis: New Tricks for Old Dogs. Clin Infect Dis. 2015 Oct 1. 61 (7):1141-3. [QxMD MEDLINE Link].

48. Zhanel GG, Zhanel MA, Karlowsky JA. Oral Fosfomycin for the Treatment of Acute and Chronic Bacterial Prostatitis Caused by Multidrug-Resistant Escherichia coli. Can J Infect Dis Med Microbiol. 2018. 2018:1404813. [QxMD MEDLINE Link]. [Full Text].

49. Cunha BA, Gran A, Raza M. Persistent extended-spectrum β-lactamase-positive Escherichia coli chronic prostatitis successfully treated with a combination of fosfomycin and doxycycline. Int J Antimicrob Agents. 2015 Apr. 45 (4):427-9. [QxMD MEDLINE Link].

50. Los-Arcos I, Pigrau C, Rodríguez-Pardo D, Fernández-Hidalgo N, Andreu A, Larrosa N, et al. Long-term Fosfomycin-tromethamine oral therapy for difficult-to-treat chronic bacterial prostatitis. Antimicrob Agents Chemother. 2015 Dec 14. [QxMD MEDLINE Link].

51. Karaiskos I, Galani L, Sakka V, Gkoufa A, Sopilidis O, Chalikopoulos D, et al. Oral fosfomycin for the treatment of chronic bacterial prostatitis. J Antimicrob Chemother. 2019 May 1. 74 (5):1430-1437. [QxMD MEDLINE Link]. [Full Text].

52. Marino A, Stracquadanio S, Bellanca CM, Augello E, Ceccarelli M, Cantarella G, et al. Oral Fosfomycin Formulation in Bacterial Prostatitis: New Role for an Old Molecule-Brief Literature Review and Clinical Considerations. Infect Dis Rep. 2022 Aug 18. 14 (4):621-634. [QxMD MEDLINE Link]. [Full Text].

53. Kwan ACF, Beahm NP. Fosfomycin for bacterial prostatitis: a review. Int J Antimicrob Agents. 2020 Oct. 56 (4):106106. [QxMD MEDLINE Link].

54. Magri V, Montanari E, Marras E, Perletti G. Aminoglycoside antibiotics for NIH category II chronic bacterial prostatitis: A single-cohort study with one-year follow-up. Exp Ther Med. 2016 Oct. 12 (4):2585-2593. [QxMD MEDLINE Link].

55. Shoskes DA, Thomas KD, Gomez E. Anti-nanobacterial therapy for men with chronic prostatitis/chronic pelvic pain syndrome and prostatic stones: preliminary experience. J Urol. 2005 Feb. 173(2):474-7. [QxMD MEDLINE Link].

56. Anothaisintawee T, Attia J, Nickel JC, et al. Management of chronic prostatitis/chronic pelvic pain syndrome: a systematic review and network meta-analysis. JAMA. 2011 Jan 5. 305(1):78-86. [QxMD MEDLINE Link].

57. Cohen JM, Fagin AP, Hariton E, Niska JR, Pierce MW, Kuriyama A, et al. Therapeutic intervention for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): a systematic review and meta-analysis. PLoS One. 2012. 7 (8):e41941. [QxMD MEDLINE Link]. [Full Text].

58. Zeng X, Ye Z, Yang W, Liu J, Zhang X, Zhou X, et al. [Clinical evaluation of celecoxib in treating type IIIA chronic prostatitis]. Zhonghua Nan Ke Xue. 2004 Apr. 10 (4):278-81. [QxMD MEDLINE Link].

59. Zhao WP, Zhang ZG, Li XD, Yu D, Rui XF, Li GH, et al. Celecoxib reduces symptoms in men with difficult chronic pelvic pain syndrome (Category IIIA). Braz J Med Biol Res. 2009 Oct. 42 (10):963-7. [QxMD MEDLINE Link].

60. Pontari MA, et al; Chronic Prostatitis Collaborative Research Network-2. Pregabalin for the treatment of men with chronic prostatitis/chronic pelvic pain syndrome: a randomized controlled trial. Arch Intern Med. 2010 Sep 27. 170 (17):1586-93. [QxMD MEDLINE Link]. [Full Text].

61. Nickel JC, Roehrborn C, Montorsi F, Wilson TH, Rittmaster RS. Dutasteride reduces prostatitis symptoms compared with placebo in men enrolled in the REDUCE study. J Urol. 2011 Oct. 186 (4):1313-8. [QxMD MEDLINE Link].

62. Nickel JC, Downey J, Pontari MA, Shoskes DA, Zeitlin SI. A randomized placebo-controlled multicentre study to evaluate the safety and efficacy of finasteride for male chronic pelvic pain syndrome (category IIIA chronic nonbacterial prostatitis). BJU Int. 2004 May. 93 (7):991-5. [QxMD MEDLINE Link]. [Full Text].

63. Kaplan SA, Volpe MA, Te AE. A prospective, 1-year trial using saw palmetto versus finasteride in the treatment of category III prostatitis/chronic pelvic pain syndrome. J Urol. 2004 Jan. 171(1):284-8. [QxMD MEDLINE Link].

64. Shoskes DA, Nickel JC. Quercetin for chronic prostatitis/chronic pelvic pain syndrome. Urol Clin North Am. 2011 Aug. 38 (3):279-84. [QxMD MEDLINE Link].

65. Falahatkar S, Shahab E, Gholamjani Moghaddam K, Kazemnezhad E. Transurethral Intraprostatic Injection of Botulinum Toxin Type A for the Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Results of a Prospective Pilot Double-Blind and Randomized Placebo-Controlled study. BJU Int. 2014 Oct 13. [QxMD MEDLINE Link].

66. Meares ET. Chronic bacterial prostatitis: role of transurethral prostatectomy (TURP) in therapy. Schmiedt E, Alken JE, Bauer HW. Therapy of prostatitis. Munich, Germany: Zuckerschwerdt Verlag; 1986. 193-197.

67. Murphy AB, Macejko A, Taylor A, Nadler RB. Chronic prostatitis: management strategies. Drugs. 2009. 69(1):71-84. [QxMD MEDLINE Link].

68. [Guideline] Bonkat G (Chair), Bartoletti R, Bruyere F, et al. EAU Guidelines on Urological Infections. uroweb.org. Available at https://uroweb.org/guidelines/urological-infections/chapter/the-guideline. 2023; Accessed: May 13, 2023.

Samantha D Kraemer, MD Research Assistant, Department of Urology, William Beaumont Hospital

Samantha D Kraemer, MD is a member of the following medical societies: American Medical Student Association/Foundation, American Medical Women's Association, American Urological Association, Michigan State Medical Society

Disclosure: Nothing to disclose.

Sugandh Shetty, MD, FRCS Associate Professor of Urology, Oakland University William Beaumont School of Medicine; Attending Physician, Department of Urology, William Beaumont Hospital

Sugandh Shetty, MD, FRCS is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Edward David Kim, MD, FACS Professor of Urology, Department of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American Society for Reproductive Medicine, American Urological Association, Sexual Medicine Society of North America, Society for Male Reproduction and Urology, Society for the Study of Male Reproduction, Tennessee Medical Association

Disclosure: Nothing to disclose.

Sunil K Ahuja, MD Department of Urology, Kaiser Permanente San Jose Medical Center

Sunil K Ahuja, MD is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Joe D Mobley, III, MD, MPH Urologist, Kentucky Lake Urology Clinic

Joe D Mobley, III, MD, MPH is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Endourological Society, Tennessee Medical Association

Disclosure: Nothing to disclose.

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