Comments from Expert Advisory Committee
- Acute prostatitis is a rare potentially serious bacterial infection of the prostate.
- It is usually caused by bacteria from the urinary tract i.e. E. Coli, Proteus, Klebsiella.
- Less commonly, it can be caused by sexually transmitted infections such as chlamydia or gonorrhoea.
Diagnosis
- Consider acute prostatitis diagnosis in a man presenting with:
- Perineal/suprapubic pain (or may have penile, low back pain, pain on opening bowels or pain with ejaculation)
- Tender, swollen prostate on rectal examination.
- Urinary symptoms including dysuria, frequency, urgency or acute urinary retention
- Always consider acute prostatitis when diagnosing a UTI in a man if there are more than the usual symptoms
- Due to increasing resistance, it is essential to send an MSU so culture can guide antibiotic treatment if no clinical response to first choice.
- Review after 14 days and either stop antibiotics or continue for a further 14 days if necessary based on assessment of history, symptoms, clinical examination and MSU result.
- 4 week treatment may prevent chronic infection i.e. chronic prostatitis, but it is difficult to predict those at risk.
- A full STI screen should be undertaken to rule out other aetiologies. Further information on STI Consultations in Primary Care is available.
Treatment
- Paracetamol with/ without codeine (and/ or ibuprofen if appropriate) should be advised for pain relief
- Advise patients about drinking enough fluids to avoid dehydration.
| Drug |
Dose |
Duration |
+/- Notes |
| 1st choice options |
| Ciprofloxacin |
500 mg every 12 hours |
14 days then review |
Review after 14 days and either stop antibiotics or continue for a further 14 days if necessary based on assessment of history, symptoms, clinical examination and MSU result.
Caution with use of ciprofloxacin – see fluoroquinolone warning below. |
| OR |
|
Trimethoprim (if ciprofloxacin not suitable)
|
200 mg every 12 hours |
14 days then review |
| 2nd choice options |
| Alternative options should be based on results of culture and susceptibility or on the advice of Consultant Microbiologist. |
Patient Information
Visit https://www.nhs.uk/conditions/prostatitis/ for patient information on prostatitis
Reviewed December 2021
