Prostatitis

Background

1. E. coli involved in 80% of cases
2. Risk factors:
   1. Urinary Tract Obstruction
   2. Epididymitis
   3. Urethritis
   4. Unprotected rectal intercourse
   5. Phimosis
   6. Indwelling urethral catheter

Diagnosis

Acute Prostatitis

• Clinical diagnosis (UA and Ucx may be normal)
  • Dysuria/urgency/frequency, perineal pain/low back pain, fever
  • Rectal exam: Exquisitely tender and boggy prostate

Chronic Prostatitis

• Similar to acute prostatitis with exception of fever/chills
• Rectal exam is often unremarkable

Work-Up

• UA, Ucx

DDx

1. Cystitis
2. Pyelonephritis

Treatment

1. Abx
   1. 4-6 wk course
   2. Cipro 500mg PO BID OR
   3. Bactrim DS 1 tab PO BID (less expensive but also less efficacious)
2. IV antibiotics
   1. Cipro 400mg IV q12 OR Levofloxacin 500mg IV q24
   2. OR Ceftriaxone 2g IV q24 +/- Gentamycin 3-5mg/kg/day

Disposition

1. Admit toxic pts or pts with urinary retention
2. Urology f/u

Source

Rosens, Tintinalli