Treatment of Acute Bacterial Prostatitis in Adults (Age 18+) Able to Take Oral Antibiotics
This protocol addresses acute bacterial prostatitis in patients aged 18 years and over who are able to take oral medicines, whose condition severity does not require intravenous antibiotics, and for whom fluoroquinolone antibiotics are clinically appropriate.
Clinical Scenario
First-line · Oral route · Adults 18+
Antibiotic therapy is indicated for patients presenting with acute prostatitis. When the patient can manage oral medication and their clinical condition does not warrant intravenous treatment, oral antibiotics are recommended first line.
The choice of antibiotic should be guided by local antimicrobial resistance data. In this scenario, fluoroquinolone antibiotics are appropriate based on the patient's suitability profile.
Treatment Approach
The first-line approach involves a defined course of an oral fluoroquinolone antibiotic, followed by a mandatory clinical review to determine whether further treatment is required. The specific agent, the duration, and the criteria guiding the review decision are set out in the full protocol.
Clinical Goals
- Symptoms of acute prostatitis begin to improve within 48 hours of starting the antibiotic.
- Resolution of fever at clinical review.
- Resolution of lower urinary tract symptoms: dysuria, urinary frequency, and urinary urgency.
- Absence of acute urinary retention at clinical review.
Patients should seek prompt reassessment if symptoms worsen at any time or do not begin to improve within 48 hours.
References
- Offer an antibiotic to people with acute prostatitis.
- When prescribing an antibiotic for acute prostatitis, take account of local antimicrobial resistance (AMR) data from Public Health England and follow table 1 for adults aged 18 years and over.
- Give oral antibiotics first line if the person can take oral medicines, and the severity of their condition does not require intravenous antibiotics.
- First-choice oral antibiotics (guided by susceptibilities when available).
- Ciprofloxacin: 500 mg twice a day for 14 days then review.
- Ofloxacin: 200 mg twice a day for 14 days then review.
- Review antibiotic treatment after 14 days and either stop the antibiotic or continue for a further 14 days if needed, based on an assessment of the person's history, symptoms, clinical examination, urine and blood tests.
- Seeking medical help if symptoms worsen at any time, or symptoms do not start to improve within 48 hours of taking the antibiotic, or the person becomes systemically very unwell.
- Continued symptoms, such as fever or lower urinary tract symptoms (dysuria, frequency, urgency, or acute urinary retention) require ongoing treatment.
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