Synopsis
Recognise acute bacterial prostatitis, distinguish sepsis and retention, obtain useful cultures and prescribe prostate-penetrating treatment with an explicit fourteen-day review.
- Acute bacterial prostatitis causes fever, pelvic or perineal pain and urinary symptoms, sometimes with retention or sepsis.
- A gentle rectal examination may support diagnosis, but do not massage an acutely inflamed prostate.
- Send a midstream urine culture before antibiotics and take blood cultures when febrile or systemically unwell.
Key red flags
Hypotension, tachypnoea, confusion or mottling indicates sepsis requiring emergency escalation.
Fever, rigors, malaise, dysuria, frequency and urgency with perineal, rectal, penile or low-back pain supports acute bacterial prostatitis.
Investigation priorities
Confirm the organism and guide a prostate-penetrating regimen before antibiotics.
Management branches
Acute bacterial prostatitis is likely, oral absorption is reliable and there is no sepsis, retention or abscess concern.
- Obtain culture and assess renal function, allergy, previous isolates, recent antibiotics, interactions and individual fluoroquinolone adverse-effect risk.
- Choose a prostate-penetrating NICE regimen: ciprofloxacin or ofloxacin only when appropriate, or trimethoprim when a fluoroquinolone is unsuitable and resistance risk permits.
Key medicines
CiprofloxacinGive 500 mg orally twice daily for 14 days, then review and stop or continue for a further 14 days according to response.
OfloxacinGive 200 mg orally twice daily for 14 days, then review and stop or continue for a further 14 days according to response.