Prostatitis

Duration

28 days

First Line

Ciprofloxacin 500mg PO every 12 hours

This should be changed to trimethoprim 200mg PO every 12 hours if the causative organism is confirmed to be susceptible, to decrease the risk of C. difficile infection.

Notes

Patients with bacterial prostatitis present acutely ill, with classical symptoms of UTI in addition to fever, chills, malaise, perineal or pelvic pain, and voiding symptoms ranging from hesitancy and dribbling to urinary retention. They may also complain of pain at the tip of the penis, or in the perineal area. On rectal digital examination, the prostate is exquisitely tender, swollen and hot.

At least 50% of men with recurrent UTI and over 90% of men with febrile UTI have prostate involvement, which may lead to complications such as prostatic abscess or chronic bacterial prostatitis.

Ensure a urine culture is sent to microbiology and adjust treatment accordingly.

While quinolones like ciprofloxacin should not be used for treatment of mild or moderate infections –see MHRA warning (2019) -  empirical use in prostatitis is justifiable, as the agent has good penetration into prostatic tissue and lower resistance rates in urinary gram negatives (17-20%) than trimethoprim.