Acute Bacterial Prostatitis

Acute bacterial prostatitis should be suspected in men presenting with symptoms of UTI. Age and immunodeficiency contribute to men having UTIs, so prostatitis is more likely in otherwise healthy men with these symptoms (Lipsky, 1999). Patients may have UTI symptoms (e.g., dysuria, frequency, urgency) and typically systemic symptoms of acute illness, such as fever, chills, and myalgias. Local discomfort in the form of pelvic or back pain is also typical. Examination reveals a tender, boggy prostate. Most experts have recommended against prostate massage in acute prostatitis because it would be very uncomfortable and theoretically could disseminate the infection (Benway and Moon, 2008; Wagenlehner and Naber, 2003).

Urine culture is typically positive for the causative organism. Treatment is empiric pending the results. Depending on the degree of illness, patients may need an IV broad-spectrum penicillin or third-generation cephalosporin, possibly with an aminoglycoside, or a fluoroquinolone (Wagenlehner and Naber, 2003). Less severe cases can be managed with oral antibiotics. Options include fluoroquinolones and tri-methoprim-sulfamethoxazole (TMP-SMX) (Lipsky, 1999). An alternative when STI is likely is intramuscular (IM) cef-triaxone followed by oral doxycycline. Antibiotic therapy is typically 10 to 14 days, although some recommend 4 weeks because of concerns about antibiotics poorly penetrating prostatic tissue. Obstructive uropathy may result from pros-tatic enlargement; thus, assessment for this clinically or with postvoid residual assessment should be considered (Benway and Moon, 2008).

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