Acute and Chronic Prostatitis - Primary Care

Publication: 30/09/2010  --
Last review: 08/04/2015  
Next review: 31/01/2019  
Clinical Guideline
UNDER REVIEW 
ID: 2248 
Approved By:  
Copyright© Leeds Teaching Hospitals NHS Trust 2015  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

The European Medicines Agency’s Pharmacovigilance Risk Assessment Committee has recommended restricting the use of fluoroquinolone antibiotics following a review of disabling and potentially long-lasting side effects mainly involving muscles, tendons, bones and the nervous system. This includes a recommendation not to use them for mild or moderately severe infections unless other antibiotics cannot be used (MHRA advice November 2018).

Acute and Chronic Prostatitis in Primary Care

Consider Chlamydia, epididymo-orchitis/prostatitis in differential diagnosis of Male presenting with dysuria
Other symptoms include distressing but poorly localized pain and is often associated with systemic findings (e.g. malaise and fever)
Send MSU on all patients before commencing therapy. Send STI screen on all patients with suspected STI-related proststitis
50% recurrent UTI’s and 90% of febrile UTI’s in adult men have prostatic involvement - if symptoms recur or fail to respond to treatment consider referral to a Specialist.
Acute infection characterized by recent onset of symptoms
Chronic infection characterized by symptoms of 3 months duration or more
Severe infection should be suspected if patient is systemically unwell or is bacteraemic

Consider referral to specialist if diagnosis of prostatitis likely.

  

Recommended Treatments

Notes

Acute Severe

Admit for IV Antibiotics if systemically unwell (usual total duration 2 weeks then review)

Empiric therapy should be modified to targeted therapy based on culture and sensitivity results.

Acute Mild Ciprofloxacin electronic Medicines Compendium information on Ciprofloxacin PO 500mg 12-hourly for 2-4 weeks
OR
Trimethoprim PO 200mg 12-hourly for 2 weeks then review
See separate Guideline for treatment of STI associated prostatitis
Chronic Treatment of Chronic Prostatitis can usually be delayed until culture and susceptibility results are available. Co-trimoxazole electronic Medicines Compendium information on Co-trimoxazole at 960mg PO 12-hourly can be used instead of Trimethoprim

HPA, QRG, SIGN88, CKS, CKS 

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Provenance

Record: 2248
Objective:
  • to provide a simple, empirical approach to the treatment of common infections
  • to promote the safe, effective and economic use of antibiotics
  • to minimise the emergence of bacterial resistance and reduce the incidence of Healthcare Associated Infections in the community
Clinical condition:

Acute Prostatitis

Target patient group:
Target professional group(s): Primary Care Doctors
Pharmacists
Adapted from:

Evidence base

Not supplied

Document history

LHP version 1.0

Related information

Not supplied