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Prostatitis - acute - Management
Basis for recommendation

These recommendations are in line with UK guidelines [RCGP and BASHH, 2006; BASHH, 2008; HPA and Association of Medical Microbiologists, 2008], and international guidelines [Naber et al, 2001; European Association of Urology, 2008; Ludwig, 2008].

Choice of antibiotic

  • These recommendations are based on expert opinion because there is no evidence from controlled clinical trials of quinolones or trimethoprim for acute prostatitis.
  • Treatment with a quinolone or trimethoprim results in high concentrations of these drugs in the prostate.
  • Quinolones and trimethoprim are effective treatments for most of the likely pathogens.
  • Other antibiotics either do not penetrate the prostate as well, or are less effective against urinary pathogens.
  • Quinolones are preferred to trimethoprim because they are effective against a wider range of urinary pathogens.
  • There is no evidence to suggest that any particular quinolone is more effective or more hazardous than any other. CKS recommendations of ciprofloxacin or ofloxacin are consistent with those made by the British Association for Sexual Health and HIV (BASHH) [BASHH, 2008].
  • The benefits of antibiotic treatment outweigh any increased risk of infection with Clostridium difficile or meticillin-resistant Staphylococcus aureus (MRSA), and the risk of promoting resistance to quinolones.

Duration of antibiotic treatment

  • CKS recommendations are in line with UK guidelines, which recommend treatment for at least 4 weeks to prevent the development of chronic prostatitis [BASHH, 2008]. However, European guidelines would consider 10 days' treatment adequate [European Association of Urology, 2008].

Choice of stool softener

  • Laxatives other than docusate and lactulose are not recommended:
    • Bulk-forming agents may not ease defecation, and it will be several days before they take effect.
    • Stimulant agents will not soften the stool.
    • Enemas and rectal preparations are likely to be painful to insert.
    • Co-danthrusate has limited prescribing indications.
    • Liquid paraffin is generally not recommended.

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