Rationale for antibiotic therapy for chronic bacterial prostatitis

See Approach to empirical antibiotic choice for UTI in adults for principles of antibiotic choice.

Chronic bacterial prostatitis is treated with oral antibiotic therapy based on the results of culture and susceptibility testing. Ensure the antibiotic chosen achieves adequate penetration into the noninflamed prostate.

Oral antibiotics with favourable prostate penetration are ciprofloxacin, trimethoprim, trimethoprim+sulfamethoxazole, doxycycline and azithromycinBonkat, 2024Karaiskos, 2019. Oral beta lactams (such as amoxicillin and cefalexin) have poor penetration into the noninflamed prostate and are not recommended for chronic bacterial prostatitisLam, 2023.

Doxycycline and azithromycin are used for the treatment of chronic bacterial prostatitis caused by sexually transmissible pathogens (eg Chlamydia trachomatis, Neisseria gonorrhoeae)Bonkat, 2024.

Fosfomycin may be an option for treatment of chronic bacterial prostatitis caused by some multidrug-resistant bacteria, but more information is needed before it can be recommendedKaraiskos, 2019Lam, 2023; seek expert advice.