Acute prostatitis

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    Prostatitis is an acute bacterial infection of the prostate.

    The most common causative pathogen is Escherichia coli. Other pathogens include Proteus mirabilis, Klebsiella sp, Pseudomonas aeruginosa and Enterococcus sp.

    Progression to chronic prostatitis is possible.

    Clinical features

    • Fever (often high) and chills.
    • Signs of cystitis (burning on urination and urinary frequency).
    • Perineal, urethral, penile or rectal pain.
    • Urinary retention.

     

    On examination:

    • Very painful digital rectal examination. Fluctuant mass in case of prostatic abscess.
    • Leukocyturia, pyuria, possible macroscopic haematuria.

    Treatment

    • Antibiotic therapy:
      ciprofloxacin PO: 500 mg 2 times daily for 14 days then review the patient. Stop treatment if signs and symptoms have completely resolved. If signs and symptoms are ongoing continue the same treatment for a further 14 days. [1] Citation 1. National Institute for Health and Care Excellence. NICE guideline [NG110] Prostatitis (acute): antimicrobial prescribing, 2018.
      https://www.nice.org.uk/guidance/ng110/resources/visual-summary-pdf-6544018477 [Accessed 4 March 2020]
    • Symptomatic treatment:
      • Ensure adequate hydration (1.5 litres daily).
      • Treat fever (Chapter 1) and pain (Chapter 1).
    • Refer to a surgeon in case of suspected prostatic abscess.

     

    References