Acute Bacterial Prostatitis in Adults Unable to Take Oral Antibiotics or Severely Unwell — When First-Choice IV Antibiotics Have Not Worked
This protocol applies to adults aged 18 and over with acute bacterial prostatitis who are severely unwell or unable to take oral antibiotics, and who have not achieved the expected clinical response on first-choice intravenous antibiotic treatment.
Clinical Scenario
Adults aged 18 years and over presenting with acute bacterial prostatitis who are either severely unwell or unable to tolerate oral antibiotics, now requiring a next-step management decision after first-choice intravenous antibiotics have been given.
Previous Line: First-Choice IV Antibiotics — Goals Not Achieved
Initial treatment with first-choice intravenous antibiotics — Ciprofloxacin, Levofloxacin, Cefuroxime, Ceftriaxone, Gentamicin, or Amikacin — did not achieve the following targets:
- Clinical improvement within 48 hours sufficient to consider stepping down to oral antibiotics
- At 14-day review: resolution of fever and lower urinary tract symptoms (dysuria, urinary frequency, urinary urgency)
- Absence of acute urinary retention
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.
- First-choice intravenous antibiotics (if unable to take oral antibiotics or severely unwell; guided by susceptibilities when available).
- Consult a local microbiologist