Prostatitis

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Background

  1. Infection of the prostate caused by gram negative organisms, 80% E. coli.

Acute Prostatitis

  1. Symptoms: dysuria/urgency/frequency, perineal pain, low back pain, fever, chills
  2. Rectal exam (mandatory in men with symptoms of cystitis): exquisitely tender and boggy prostate, warm to touch

Chronic Prostatitis

  1. Relapsing UTI caused by the same organism, may have history of acute prostatitis
  2. Symptoms: same as acute with exception of fever/chills
  3. Rectal exam: often unremarkable

Diagnosis

  1. UA: typically accompanied by cystitis
  2. Urine Culture: reveals responsible bacteria
  3. rectal exam: tender prostate gland (acute)

Work-Up

  1. UA, Urine culture
  2. Prostate exam
  3. Chemistry for renal function

DDx

  1. cystitis
  2. pyelonephritis
  3. chronic bacterial prostatitis

Treatment

  1. Antibiotics: 4-6 week course
    1. Cipro 500mg PO BID
    2. OR Bactrim DS 1 tab PO BID
  2. IV antibiotics (toxic prostatitis)
    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 patients or patients with urinary retention
  2. Urology follow, chronic prostatitis may require 16 weeks of therapy

Source

Adapted from Rosens 7th Edition

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