Acute prostatitis


– 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

– 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

  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]