Modification and duration of intravenous therapy for acute bacterial prostatitis

Modify therapy for acute bacterial prostatitis based on the results of culture and susceptibility testing.

If the results of susceptibility testing are not available by 72 hours after the initial empirical antibiotic dose, intravenous therapy is still required, and gentamicin or tobramycin was used initially, switch to ceftriaxone (as above).

Intravenous ambulatory antimicrobial therapy should only be used when appropriate oral antibiotics are not available (eg for some multidrug-resistant infections) – seek expert advice. If susceptible, an option for intravenous ambulatory antimicrobial therapy for extended-spectrum beta-lactamase (ESBL)-producing bacteria is ertapenem because it is given once daily; however, susceptibility to ertapenem must be confirmed – discuss with a clinical microbiologist.

Switch to an oral antibiotic regimen once the patient is clinically stable and able to tolerate and absorb oral therapy – see Guidance for intravenous to oral switch. Oral therapy should be based on the results of culture and susceptibility testing and prostate penetration of the antibiotic. If the results of susceptibility testing are not available, see Oral antibiotic regimens for acute bacterial prostatitis for oral regimens.

The total duration of therapy (intravenous + oral) for acute bacterial prostatitis is usually 2 weeksBonkat, 2024National Institute for Clinical Excellence (NICE), 2018Nelson, 2024. Extend therapy to 4 weeks if the infection has not resolved completely by the end of the treatment courseBonkat, 2024National Institute for Clinical Excellence (NICE), 2018.

Confirm the infection has resolved by repeating urine culture 1 week after treatment is completed.