Oral antibiotic regimens for acute bacterial prostatitis

Acute bacterial prostatitis is often painful – offer adequate analgesia with paracetamol in addition to antibiotic therapy.

See Approach to empirical antibiotic choice for UTI in adults and Rationale for oral antibiotic therapy for acute bacterial prostatitis for a discussion of antibiotic choice.

For empirical oral therapy for acute bacterial prostatitis, while awaiting the results of microscopy, culture and susceptibility testing, useCharalabopoulos, 2003Lam, 2023National Institute for Clinical Excellence (NICE), 2018:

1ciprofloxacin 500 mg orally, 12-hourly for 14 days. For dosage adjustment in adults with kidney impairment, see ciprofloxacin oral dosage adjustment ciprofloxacin

OR

2trimethoprim 300 mg orally daily for 14 days. For dosage adjustment in adults with kidney impairment, see trimethoprim dosage adjustment trimethoprim

OR

2trimethoprim+sulfamethoxazole 160+800 mg orally, 12-hourly for 14 days. For dosage adjustment in adults with kidney impairment, see trimethoprim+sulfamethoxazole dosage adjustment. trimethoprim + sulfamethoxazole

Modify empirical therapy based on the results of culture and susceptibility testing.

Assess the response to therapy after 48 to 72 hours or earlier if the patient is deteriorating; if the patient is not improving clinically, consider if the patient is at risk of a UTI caused by multidrug-resistant gram-negative bacteria or a sexually transmissible infection (STI), and reconsider the diagnosis of acute bacterial prostatitis.

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