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Prostatitis and Prostatodynia

Acute Bacterial Prostatitis

Acute bacterial prostatitis is characterized by abrupt onset of fever and chills with symptoms of urinary tract infection or obstruction, low back or perineal pain, malaise, arthralgia, and myalgias. The patient appears acutely ill and is usually a younger man. Urinary retention may

Physical Exam: The prostate is enlarged, indurated, very tender, and warm. Prostate massage is contraindicated because it is painful and may cause

Laboratory Evaluation

Urine reveals WBC's. Culture reveals gram-negative organisms such as E coli or other Enterobacteriaceae.

Nosocomial infections are often associated with a Foley catheter and may be caused by Pseudomonas, enterococci, S. aureus prosatitis

Imaging may be needed in severely ill patients to rule out an abscess and need for surgery.

Treatment requires 28 days of antibiotic treatment. A fluoroquinolone, such as ofloxacin is the drug of choice.

Ofloxacin (Floxin) 400 mg PO/IV bid.

Ciprofloxacin (Cipro) 500 mg PO bid.

Norfloxacin (Noroxin) 400 mg PO bid.

Trimethoprim/SMX (TMP-SMX, Septra) 160/800 mg (1 DS tab) PO bid.

Doxycycline (Vibramycin) 100 mg PO bid.

Extremely Ill Septic Patients with High Fever

Hospitalization for bed rest, hydration, analgesics, antipyretics, stool softeners.

Ampicillin 1 gm IV q4-6h AND Gentamicin or tobramycin - loading dose of 100-120 mg IV (1.5-2 mg/kg); then 80 mg IV q8h (2-5 mg/kg/d) OR

Ciprofloxacin (Cipro) 200 mg IV q12h.

A Foley catheter should not be used (suprapubicdrainage may be needed).

Chronic Bacterial

Chronic prostatitis is characterized by recurrent urinary tract infections, typically in older patients, perineal, low back or suprapubic pain, testicular, penile pain or discomfort, voiding dysfunction, post-ejaculatory pain, and intermittent hematospermia. Chills and fever are not present. Often symptoms are subtle.

Exam: Prostate is usually normal and nontender, but it may occasionally be enlarged and tender.

Laboratory Evaluation

Urinalysis and culture usually shows low grade bacteriuria (E. coli or other Gram negative Enterobacteriaceae, Enterococcus faecalis, S. aureus, coagulase negative staph).

Microscopic examination of express prostatic secretions reveals more than 10-15 WBC's per high-power field.

Long-term Treatment (16 weeks): Infection may be difficult to eradicate.

A fluoroquinolone is the drug of choice.

Ofloxacin (Floxin) 200-400 mg PO/IV bid.

Ciprofloxacin (Cipro) 250-500 mg PO bid.

Trimethoprim/sulfamethoxazole (TMP-SMZ, Septra) 160/800 mg (1 DS tab) PO bid.

Doxycycline (Vibramycin) 100 mg PO bid.

Suppression is indicated if recurrent symptomatic infections: Fluoroquinolone, TMP/SMX (1 single-strength tab qd), or nitrofurantoin (100 mg qd).

Chronic Nonbacterial Prostatitis

The most common type is nonbacterial. It is eight times more frequent than bacterial prostatitis.

It is characterized by