Prostatitis, Acute Bacterial

For further information, see CMDT Part 23-03: Genitourinary Tract Infections

Key Features

Essentials of Diagnosis

• Fever

• Irritative voiding symptoms

• Perineal or suprapubic pain

• Exquisite tenderness on rectal examination

• Positive urine culture

General Considerations

• Usual causative organisms: Escherichia coli and Pseudomonas

• Less common: Enterococcus

Clinical Findings

Symptoms and Signs

• Perineal, sacral, or suprapubic pain

• Fever

• Irritative voiding complaints

• Obstructive symptoms

• Urinary retention

• Exquisitely tender prostate

Differential Diagnosis

• Epididymitis

• Diverticulitis

• Urinary retention from benign or malignant prostatic enlargement

• Chronic bacterial prostatitis

• Nonbacterial prostatitis

• Chronic pelvic pain syndrome

Diagnosis

Laboratory Tests

• Complete blood count: leukocytosis and a left shift

• Urinalysis: pyuria, bacteriuria, hematuria

• Urine culture: positive

Imaging

• Pelvic CT or transrectal ultrasound is indicated in patients who do not respond to antibiotics in 24–48 hours

Treatment

Medications

• Intravenous ampicillin and an aminoglycoside until afebrile for 24–48 hours, then oral quinolone for 4–6 weeks

• Ampicillin, 1 g intravenously every 6 hours, and gentamicin, 1 mg/kg intravenously every 8 hours for 21 days

• Ciprofloxacin, 750 mg orally every 12 hours for 21 days

• Ofloxacin, 200–300 mg orally every 12 hours for 21 days

• Trimethoprim-sulfamethoxazole, 160/800 mg orally every 12 hours for 21 days (increasing resistance noted [up to 20%])

Therapeutic Procedures

• If urinary retention develops, an in-and-out catheterization to relieve the initial obstruction or short-term (12 hours) small indwelling urinary (Foley) catheter is appropriate

Outcome

Follow-Up

• Posttreatment urine culture

• Posttreatment examination of expressed prostatic secretions after completion of therapy

Prognosis

• Appropriate antibiotic therapy eradicates bacteria causing acute bacterial prostatitis

• Progression to chronic bacterial prostatitis is rare

When to Refer

• Evidence of urinary retention

• Evidence of chronic prostatitis

When to Admit

• Signs of sepsis

• Need for surgical drainage of bladder or prostatic abscess

References