Prostatitis

Prostatitis - Acute
Rahul Soman, M. Pharm

 

Definition  

A group of infectious and noninfectious clinical syndromes that cause symptoms related to the prostate gland. Prostatitis is classified as acute bacterial prostatitis (acute infection), chronic bacterial prostatitis (recurrent infection), chronic prostatitis/chronic pelvic pain syndrome (no demonstrable infection; most common type), and asymptomatic inflammatory prostatitis with no subjective symptoms .

 

Medical History  

* Urinary tract infectious disease [Urinary tract infectious disease - Acute]

* Urinary bladder stone

* Past medical history of Procedure on genitourinary system

* Urinary outflow obstruction

* Anal penetration

* Diabetes mellitus

 

Findings  

* Dysuria

* Increased frequency of urination

* Pelvic and perineal pain

* Prostate tender

* Swollen prostate

* Urinary retention

* Arthralgia

* Backache

* Fever with chills

* Myalgia

* Nausea

* Pain in penis

* Vomiting

 

Tests  

 

Suspected prostatitis  

* Urinalysis: Urinalysis of a midstream urine sample in a patient with prostatitis may reveal WBCs, bacteria or hematuria .

 

Suspected prostatitis  

* Urine culture: Acute bacterial prostatitis is caused by the same organisms responsible for urinary tract infections .

 

Suspected chronic prostatitis  

* Two glass urine test (Thompson's test): The pre- and post-massage test is a simple, cost-effective screening method for bacterial prostatitis, showing bacteria and elevated WBC in prostatic fluid and urine .

 

Suspected and known sepsis  

* Blood culture: In patients with suspected sepsis, at least 2 sets of blood cultures should be obtained, preferably from peripheral venipuncture before antimicrobial therapy is initiated, if obtaining such cultures does not cause a significant delay in antibiotic administration .

 

Differential Diagnosis  

* Bacterial prostatitis, acute

* Bacterial prostatitis, chronic

* Chronic prostatitis - chronic pelvic pain syndrome

* Urinary tract infectious disease - Acute

* Urethritis

* Benign prostatic hyperplasia

* Neoplasm of prostate

* Epididymitis - Acute

* Injury of male perineum

* Tuberculosis of genitourinary system

* Congestion of prostate

 

Treatment  

 

Drug Therapy  

 

 

Severe acute bacterial prostatitis  

 

CEFTRIAXONE SODIUM - GENTAMICIN SULFATE  

Adults: Ceftriaxone 1 to 2 g IV every 12 to 24 hours AND gentamicin 1.7 mg IV every 8 hours

 

CEFOTAXIME SODIUM - GENTAMICIN SULFATE  

Adults: Cefotaxime 1 to 2 g IV every 6 to 8 hours (maximum 12 g/day) AND gentamicin 1.7 mg/kg IV every 8 hours

 

CIPROFLOXACIN  

Adults: 400 mg IV twice daily

 

LEVOFLOXACIN  

Adults: 750 mg IV once daily

 

OFLOXACIN  

Adults: 300 mg IV every 12 hours

 

 

Mild to moderate acute bacterial prostatitis  

 

CIPROFLOXACIN  

Adults: 500 mg orally twice daily for 28 days

 

LEVOFLOXACIN  

Adults: 500 mg orally twice daily for 28 days

 

OFLOXACIN  

Adults: 300 mg orally twice daily for 6 weeks

 

 

Chronic bacterial prostatitis  

 

CIPROFLOXACIN  

Adults: 500 mg orally twice daily for 28 days

 

LEVOFLOXACIN  

Adults: 500 mg orally daily for 28 days

 

OFLOXACIN  

Adults: 300 mg orally every 12 hours for 6 weeks

 

NORFLOXACIN  

Adults: 400 mg orally twice daily for 28 days

 

DOXYCYCLINE  

Adults: 100 mg orally twice daily for 28 days

 

 

Acute pain  

 

IBUPROFEN (Related toxicological information in IBUPROFEN)  

Adults: 200 to 800 mg orally every 6 to 8 hours as needed (maximum 3.2 g/day)

 

ACETAMINOPHEN/OXYCODONE HYDROCHLORIDE  

Adults: Oxycodone 5 to 20 mg/acetaminophen 325 to 1000 mg orally every 4 hours as needed (maximum 4 g acetaminophen/day)

 

ACETAMINOPHEN (Related toxicological information in ACETAMINOPHEN-ACUTE, ACETAMINOPHEN-REPEATED SUPRATHERAPEUTIC)  

Adults: 650 to 1000 mg orally every 4 to 6 hours as needed (maximum 4 g/day)

 

ACETAMINOPHEN/CODEINE PHOSPHATE  

Adults: Codeine 15 to 60 mg/acetaminophen 325 to 1000 mg orally every 4 hours as needed (maximum 360 mg codeine and 4 g acetaminophen/day)

 

 

Chronic bacterial and abacterial prostatitis  

 

TERAZOSIN HYDROCHLORIDE  

Adults: Escalating dose from 1 to 5 mg once orally daily; use effective dose once daily for 12 weeks

 

ALFUZOSIN HYDROCHLORIDE  

Adults: 10 mg orally twice daily for 12 weeks

 

Tamsulosin (Related toxicological information in ALPHA-ADRENERGIC BLOCKERS)  

Adults: 0.4 mg orally daily for 12 weeks

 

 

Hyperreflexion of the urinary sphincter and pelvic floor  

 

DIAZEPAM  

Adults: 2.5 to 5 mg orally twice a day until symptomatic improvement

 

Procedural Therapy  

 

Chronic prostatitis  

* Prostatic massage: Prostatic massage is contraindicated in acute bacterial prostatitis and has not been effective in patients with chronic prostatitis .

 

Suspected and known acute retention of urine  

* Insertion of catheter into urinary bladder: Catheterization may be needed to relieve bladder outlet obstruction due to prostatic edema.

 

Chronic abacterial prostatitis  

* Transrectal microwave thermotherapy to prostate: Transurethral microwave thermotherapy may be an option in patients with chronic abacterial prostatitis who do not respond to medical therapy.

 

Non-Procedural Therapy  

 

Bacterial prostatitis, acute  

* Sitz Bath

* Bed Rest