Prostatitis

Background

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

Acute Prostatitis

-Symptoms: dysuria/urgency/frequency, perineal pain, low back pain, fever, chills

-Rectal exam (mandatory in men with symptoms of cystitis): exquisitely tender and boggy prostate, warm to touch

Chronic Prostatitis

-Relapsing UTI caused by the same organism, may have history of acute prostatitis

-Symptoms: same as acute with exception of fever/chills

-Rectal exam: often unremarkable

-UA: typically accompanied by cystitis

-Urine Culture: reveals responsible bacteria

-rectal exam: tender prostate gland (acute)

-UA, Urine culture

-Prostate exam

-Chemistry for renal function

-cystitis

-pyelonephritis

-chronic bacterial prostatitis

-Antibiotics: 4-6 week course

    -Cipro 500mg PO BID

    - OR Bactrim DS 1 tab PO BID

-IV antibiotics (toxic prostatitis)

    -Cipro 400mg IV q12 OR Levofloxacin 500mg IV q24

    - OR Ceftriaxone 2g IV q24 +/- Gentamycin 3-5mg/kg/day

- Admit toxic patients or patients with urinary retention

- Urology follow, chronic prostatitis may require 16 weeks of therapy

Adapted from Rosens 7th Edition

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