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Medical Author:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Medical Editor:

Jerry R. Balentine, DO, FACEP

Jerry R. Balentine, DO, FACEP

Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

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Treatment is based on the type of infection and the susceptibility of the infecting organism to antimicrobial therapy as follows:

Acute bacterial prostatitis medical treatment

Antibiotics: Patients likely will be given trimethoprim-sulfamethoxazole (Bactrim, Septra) or fluoroquinolones (ciprofloxacin [Cipro, Cipro XR, Proquin XR], norfloxacin [Noroxin], ofloxacin [Floxin]) for at least a week, and frequently longer time periods for the common infectious agents (Gram-negative bacteria). Infrequent infectious agents (listed above) may require other antimicrobials; the best treatment is to determine the antimicrobial susceptibility of the infecting agent and use the most effective antimicrobial. This information may be supplied to the treating doctor by the laboratory personnel.

• If high fever or symptoms of a severe bacterial infection are present, the patient may be hospitalized.
• At the hospital, patients may be given antibiotics such as cephalosporins or ampicillin (Principen) plus an aminoglycoside (gentamicin, amikacin [Amikin]) intravenously.
• Sometimes the patient may need a catheter (a small tube inserted through the urethra) for relief from severe obstructions that stop urine flow.

Chronic bacterial prostatitis medical treatment

The effectiveness of antibiotics is limited because most antibiotics cannot penetrate the prostate tissue when it is not inflamed.

• Patients likely will receive sulfamethoxazole and trimethoprim (Bactrim DS, Septra DS) initially. Other potentially effective antibiotics include ciprofloxacin (Cipro), norfloxacin (Noroxin), or ofloxacin (Floxin). Patients often take antibiotics for 6 weeks; some may require antibiotics for a longer time period. Isolated organisms may show resistance to antibiotics over time, so alternate antimicrobials or alternate therapy may need to be addressed by the health care practitioner.
• Many men have a reoccurrence of the infection; however, after they stop taking antibiotics. These men may need a longer course of antibiotics or other treatments.

If a patient has a relapse or prostatic disease resistant to therapy, the doctor may continue antibiotics with prostatic massage or drainage (2 or 3 times per week). Although many clinicians may not take this approach, those that do suggest the following:

• The involved ducts and glands may be blocked, creating tiny pockets almost like abscesses.
• It is believed that prostate massage unblocks these ducts, allowing them to drain more normally, thus permitting better penetration of antibiotics.

Patients rarely need surgery, which may be considered if medication has been effective.

Other treatments may include alpha blockers (for example, tamsulosin [Flomax] or terazosin [Hytrin]) that can relax the bladder neck and muscles to help reduce the symptoms of painful urination.

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