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Prostatitis - acute - Management
How should I treat acute prostatitis?
- Admit to hospital if the man is unable to take oral antibiotics, or is severely ill.
- Start antibiotic treatment immediately, while waiting for the urine culture results.
- A quinolone (ciprofloxacin 500 mg twice daily, or ofloxacin 200 mg twice daily) for 28 days is recommended.
- If ciprofloxacin and ofloxacin cannot be taken, trimethoprim 200 mg twice daily for 28 days is recommended.
- Treat the pain:
- Paracetamol and/or ibuprofen (taken regularly) is recommended first-line.
- For severe pain, offer codeine with paracetamol.
- If defecation is painful, offer a stool softener such as docusate or lactulose.
- Advise the man to seek urgent medical advice if the condition deteriorates before their follow-up appointment.
- Reassess after 24–48 hours:
- Review the culture results and ensure that an appropriate antibiotic is being used.
- Refer to urology if the infection is not responding adequately to treatment — prostatic abscess may need to be excluded or treated.
- Following recovery, refer for investigation to exclude structural abnormality of the urinary tract.
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