Diagnosis
Definition:
How is the diagnosis made?*
H&P (Pertinent H&P findings including med review & key vital signs)
-Common presentation:
-Clinical Manifestations:
-Associated Conditions:
-Risk factors:
-Red flags:
-Complications: Prostatic abscesses, Chronic Prostatitis.
Ddx & Etiology:
Diagnostic studies:
Assess severity/acuity:
In sexually active males < 35 years of age AND in men > 35 years who engage in high-risk sexual behaviors, get a Gram stain of urethral swabs, a culture of urethral discharge, or a DNA amplification test to evaluate for N. gonorrhea and C. trachomatis.
Treatment: Cover GC & CT. Ceftriaxone 250 mg IM x one dose; or Cefixime 400 mg Orally x 1 dose PLUS Doxycycline 100 mg BID x 10-14 days with a 2-week extension if the patient remains symptomatic or 4-week treatment for severe prostatitis.
Other males (not at high risk for GC/CT)
Treatment: Quinolones: Ciprofloxacin 500 mg orally twice daily for 10 to 14 days OR Levofloxacin 500 to 750 mg orally daily for 10 to 14 days. Alternate tx: Trimethoprim/sulfamethoxazole 160/800 mg orally twice daily for 10 to 14 days. Note: Extend by 2 weeks beyond 10-14 days if still symptomatic.
IV medications: Ciprofloxacin / Levofloxacin; OR Ceftriaxone; OR Piperacillin/tazobactam; OR Cefotaxime or Ceftazidime;
Consider local patterns of Enterobacteriaceae drug resistance.
Don’t do prostate massage for Acute bacterial prostatitis.
Inpatient vs. Outpatient treatment.
R/o Prostatic abscess in patients who are still having fevers after 3 days on appropriate antibiotics.
Repeat Urine culture 1 week after finishing antibiotics to ensure clearance.
R/o out obstruction and treat with foley catheter vs. cystostomy.
“Although not all antibiotics can penetrate into prostatic tissue, the presence of acute inflammation generally allows entry of drugs that would not otherwise achieve therapeutic levels.” UTD
Further Reading
https://www.aafp.org/afp/2016/0115/p114.html