How is bacterial prostatitis diagnosed and treated?
Acute bacterial prostatitis is a urologic emergency. Patients are severely ill with high fever and prominent voiding symptoms. Broad-spectrum parenteral antimicrobial treatment is initiated following collection of urine and blood cultures. Obstruction to voiding is usually present and is managed with a short-term indwelling catheter. Initial broad-spectrum parenteral treatment is stepped down to oral therapy, preferably a fluoroquinolone, once clinically indicated and when culture results are available. The total recommended duration of the antimicrobial course is 30 days.
Chronic bacterial prostatitis is diagnosed when the voided urine culture is negative but bacterial growth and pyuria are documented in expressed prostate secretions. Only 10% of men presenting with chronic pelvic pain syndrome/chronic prostatitis symptoms have chronic bacterial prostatitis confirmed as the cause of these symptoms, so microbiologic documentation of infection is necessary. A clinical presentation in older men is recurrent cystitis when bacteria that persist in the prostate reenter the urine. Treatment for documented chronic bacterial prostatitis is 4 weeks of ciprofloxacin or levofloxacin for susceptible organisms. This regimen is 70% to 80% effective for long-term cure.
