Prostatitis: Difference between revisions
| Line 32: | Line 32: | ||
**[[Cipro]] 500mg PO BID OR | **[[Cipro]] 500mg PO BID OR | ||
**[[Bactrim DS]] 1 tab PO BID (less expensive but also less efficacious) | **[[Bactrim DS]] 1 tab PO BID (less expensive but also less efficacious) | ||
*IV | *IV | ||
**Cipro 400mg IV q12 OR [[levofloxacin]] 500mg IV q24 | **[[Cipro]] 400mg IV q12 OR [[levofloxacin]] 500mg IV q24 | ||
**OR [[ | **OR [[ceftriaxone]] 2g IV q24 +/- [[gentamycin]] 3-5mg/kg/day | ||
==Disposition== | ==Disposition== | ||
Revision as of 14:29, 22 February 2015
Background
- E. coli involved in 80% of cases
Risk Factors
- Urinary Tract Obstruction
- Epididymitis
- Urethritis
- Unprotected rectal intercourse
- Phimosis
- 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
Differential Diagnosis
Dysuria
- Genitourinary infection
- Acute cystitis ("UTI")
- Pyelonephritis
- Urethritis
- Chronic cystitis
- Infected nephrolithiasis
- Prostatitis
- Epididymitis
- Renal abscess/perinephric abscess
- Emphysematous pyelonephritis
- Nephrolithiasis
- Urethral issue
- Urethritis
- Urolithiasis
- Urethral foreign body
- Urethral diverticulum
- Allergic reaction (contact dermatitis)
- Chemical irritation
- Urethral stricture or obstruction
- Trauma to vagina, urethra, or bladder
- Gynecologic
- Vaginitis/cervicitis
- PID
- Genital herpes
- Pelvic organ prolapse
- Fistula
- Cystocele
- Other
- Diverticulitis
- Interstitial cystitis
- Behavioral symptom without detectable pathology
Treatment
Antibiotics
- 4-6 wk course
- PO
- Cipro 500mg PO BID OR
- Bactrim DS 1 tab PO BID (less expensive but also less efficacious)
- IV
- Cipro 400mg IV q12 OR levofloxacin 500mg IV q24
- OR ceftriaxone 2g IV q24 +/- gentamycin 3-5mg/kg/day
Disposition
- Admit toxic pts or pts with Urinary Retention
- Urology f/u
Source
Rosens, Tintinalli