Acute Prostatitis

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

Safe Prescribing (visit the safe prescribing page)

Reviewed December 2021

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