Acute Bacterial Prostatitis: Diagnosis

and Management
TIMOTHY J. COKER, MD, and DANIEL M. DIERFELDT, DO, Ehrling Bergquist Family Medicine Residency Program,
Offutt Air Force Base, Nebraska

Acute bacterial prostatitis is an acute infection of the prostate gland that causes pelvic pain and urinary tract symp-
toms, such as dysuria, urinary frequency, and urinary retention, and may lead to systemic symptoms, such as fevers,
chills, nausea, emesis, and malaise. Although the true incidence is unknown, acute bacterial prostatitis is estimated
to comprise approximately 10% of all cases of prostatitis. Most acute bacterial prostatitis infections are community
acquired, but some occur after transurethral manipulation procedures, such as urethral catheterization and cystos-
copy, or after transrectal prostate biopsy. The physical examination should include abdominal, genital, and digital
rectal examination to assess for a tender, enlarged, or boggy prostate. Diagnosis is predominantly made based on
history and physical examination, but may be aided by urinalysis. Urine cultures should be obtained in all patients
who are suspected of having acute bacterial prostatitis to determine the responsible bacteria and its antibiotic sensitiv-
ity pattern. Additional laboratory studies can be obtained based on risk factors and severity of illness. Radiography
is typically unnecessary. Most patients can be treated as outpatients with oral antibiotics and supportive measures.
Hospitalization and broad-spectrum intravenous antibiotics should be considered in patients who are systemically
ill, unable to voluntarily urinate, unable to tolerate oral intake, or have risk factors for antibiotic resistance. Typi-
cal antibiotic regimens include ceftriaxone and doxycycline, ciprofloxacin, and piperacillin/tazobactam. The risk of
nosocomial bacterial prostatitis can be reduced by using antibiotics, such as ciprofloxacin, before transrectal prostate
biopsy. (Am Fam Physician. 2016;93(2):114-120. Copyright © 2016 American Academy of Family Physicians.)

A
CME This clinical content cute bacterial prostatitis is an acute can cause acute bacterial prostatitis.11 Over-
conforms to AAFP criteria infection of the prostate gland that all, community-acquired infections are
for continuing medical
education (CME). See causes urinary tract symptoms three times more common than nosocomial
CME Quiz Questions on and pelvic pain in men.1 It is esti- infections.3
page 95. mated to comprise up to 10% of all prostatitis
Author disclosure: No rel- diagnoses, and its incidence peaks in persons Microbiology
evant financial affiliations. 20 to 40 years of age and in persons older Acute bacterial prostatitis is most frequently
Patient information: than 70 years.2 Most cases can be diagnosed caused by Escherichia coli, followed by Pseu-
▲

A handout on this topic is with a convincing history and physical exam- domonas aeruginosa, and Klebsiella, Entero-
available at http://family​ ination.3 Although prostatitis-like symptoms coccus, Enterobacter, Proteus, and Serratia
doctor.org/family​doctor/
have a combined prevalence of 8.2% in men, species.3,5,7,10 In sexually active men, Neis-
en/diseases-conditions/
prostatitis.html. the incidence and prevalence of acute bacte- seria gonorrhoeae and Chlamydia trachoma-
rial prostatitis are unknown.4 tis should be considered.12 Patients who are
immunocompromised (e.g., persons with
Pathogenesis human immunodeficiency virus) are more
Most cases of acute bacterial prostatitis are likely to have uncommon causes for prostati-
caused by ascending urethral infection or tis, such as Salmonella, Candida, and Crypto-
intraprostatic reflux and are facilitated by coccus species (Table 2).3,7,10,12
numerous risk factors (Table 1).4-10 These Infections that occur after transurethral
infections may occur from direct inocula- manipulation are more likely to be caused
tion after transrectal prostate biopsy and by Pseudomonas species, which have higher
transurethral manipulations (e.g., cath- rates of resistance to cephalosporins and
eterization and cystoscopy).6-8 Occasionally, carbapenems.7 Transrectal prostate biopsies
direct or lymphatic spread from the rectum can cause postoperative infections. Periop-
or hematogenous spread via bacterial sepsis erative antibiotics have reduced the rates of

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 Acute Bacterial Prostatitis
SORT: KEY RECOMMENDATIONS FOR PRACTICE

Evidence
Clinical recommendation rating References Comments

Prostatic massage should be avoided in patients suspected of having acute C 11, 12, 20, 22 Expert consensus
bacterial prostatitis.
Midstream urine culture should be used to guide antibiotic therapy for C 3, 10, 11 Prospective cohort study,
acute bacterial prostatitis. retrospective cohort study
Blood cultures are indicated in patients with a body temperature greater C 21 Prospective cohort study
than 101.1°F (38.4°C), a possible hematogenous source of infection (e.g.,
endocarditis with Staphylococcus aureus), or complicated infections (e.g.,
sepsis), and in patients who are immunocompromised.
Prostate-specific antigen testing is not indicated in the evaluation of acute C 11, 12, 20 Prospective cohort study
bacterial prostatitis.
Fevers that persist for longer than 36 hours should be evaluated with C 27 Expert opinion
imaging to rule out prostatic abscess.
Acute bacterial prostatitis occurring after a transrectal prostate biopsy should C 15-18, 24 Multiple retrospective
be treated with broad-spectrum antibiotics to cover fluoroquinolone- cohort studies and one
resistant bacteria and extended spectrum beta-lactamase–producing prospective cohort study
Escherichia coli.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented
evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

postoperative prostatitis to between 0.67% and 2.10% should prompt physicians to determine if patients meet
of cases, but have increased the incidence of prostati- clinical criteria for sepsis.
tis caused by fluoroquinolone-resistant bacteria and The physical examination should include an abdomi-
extended spectrum beta-lactamase–producing E. coli.13-18 nal examination to detect a distended bladder and costo-
vertebral angle tenderness, a genital examination, and a
Clinical Presentation digital rectal examination. A digital rectal examination
Patients with acute bacterial prostatitis often present should be performed gently because vigorous prostatic
with acute onset of irritative (e.g., dysuria, urinary fre- massage can induce bacteremia, and subsequently, sep-
quency, urinary urgency) or obstructive (e.g., hesitancy, sis.9,11,20 In a patient with acute bacterial prostatitis, the
incomplete voiding, straining to urinate, weak stream) prostate will often be tender, enlarged, or boggy. If there
voiding symptoms. Patients may report suprapubic, rec- is concern for obstructed voiding, postvoid residual urine
tal, or perineal pain.6,9,11 Painful ejaculation, hemato- volumes should be measured using ultrasonography.
spermia, and painful defecation may be present as well.19 Several conditions present with similar symptoms and
Systemic symptoms, such as fever, chills, nausea, eme-
sis, and malaise, commonly occur, and their presence
Table 2. Pathogens in Acute Prostatitis

Common* Uncommon
Table 1. Risk Factors for Acute Bacterial
Escherichia coli (> 50% Chlamydia trachomatis
Prostatitis of cases) Fungi (Aspergillus, Candida,
Pseudomonas Cryptococcus, and Histoplasma
Benign prostatic hypertrophy* Immunocompromised aeruginosa species)
Genitourinary infections* Phimosis Klebsiella species Mycobacterium tuberculosis
Epididymitis Prostate manipulation* Enterococcus species Mycoplasma genitalium
Orchitis Cystoscopy Enterobacter species Neisseria gonorrhoeae
Urethritis Transrectal prostate biopsy Proteus species Salmonella species
Urinary tract infection Transurethral surgery Serratia species Staphylococcus species
High-risk sexual behavior Urethral catheterization Streptococcus species
History of sexually Urodynamic studies Trichomonas vaginalis
transmitted diseases* Urethral stricture Ureaplasma urealyticum

*—Higher risk for infection. *—Listed in approximate order of frequency.

Information from references 4 through 10. Information from references 3, 7, 10, and 12.

January 15, 2016 ◆ Volume 93, Number 2 www.aafp.org/afp American Family Physician 115
Acute Bacterial Prostatitis
Table 3. Differential Diagnosis of Acute Bacterial Prostatitis

Diagnosis Distinguishing characteristics

Benign prostatic Obstructive voiding symptoms; enlarged, nontender

must be differentiated from acute bacterial hypertrophy prostate; negative urine culture
prostatitis (Table 3). Chronic bacterial Recurring prostatitis symptoms for at least three months;
prostatitis positive urine culture with each episode
Evaluation Chronic pelvic Pain attributed to the prostate with no demonstrable
A convincing history and physical exami- pain syndrome evidence of infection
nation are typically sufficient to diagnose Cystitis Irritative voiding symptoms; normal prostate examination
acute bacterial prostatitis. Physicians should Diverticulitis Left lower-quadrant abdominal pain; acute change in
bowel habits; history of diverticulitis; tenderness to
obtain a urinalysis and midstream urine cul-
palpation localized to the left lower abdominal quadrant
ture to support the clinical diagnosis before Epididymitis Irritative voiding symptoms; tenderness to palpation on
administering antibiotics.3,10,11 affected epididymis
Blood cultures should be collected before Orchitis Swelling, pain, and/or tenderness to palpation in one or
initiating antibiotics in patients with a body both testicles
temperature greater than 101.1°F (38.4°C), Proctitis Tenesmus; rectal bleeding; feeling of rectal fullness;
a possible hematogenous source of infec- passage of mucus through the rectum

tion (e.g., endocarditis with Staphylococcus Prostate cancer Presence of constitutional symptoms; presence of nodules
on prostate examination
aureus), complicated infections (e.g., sep-
sis), or who are immunocompromised.11,21
Although blood and urine cultures can aid
in diagnosis and management, up to 35% of urine cul- be elevated, but these tests have minimal clinical or diag-
tures in patients with acute prostatitis will fail to grow nostic utility.23
an organism.3 Prostate-specific antigen (PSA) levels are not indicated
In men younger than 35 years who are sexually active, in the workup of acute bacterial prostatitis.11,12,20 Approx-
and in men older than 35 years who engage in high-risk imately 70% of men will have a spurious PSA elevation
sexual behavior, a Gram stain of urethral swabs, a cul- due to disruption of prostatic architecture caused by
ture of urethral discharge, or a DNA amplification test inflammation.19 Elevated PSA levels can persist for one to
should be obtained to evaluate for N. gonorrhoeae and two months after treatment.11,12 If PSA levels remain ele-
C. trachomatis.11,22 vated for more than two months, prostate cancer should
Urine testing before and after prostatic massage (also be considered because 20% of persistent elevations are
known as the Meares-Stamey 2-glass or 4-glass test) is associated with malignancy.19
useful in diagnosing chronic prostate and pelvic dis-
orders; however, such testing should not be performed IMAGING
in patients with suspected acute bacterial prostatitis Imaging studies are usually unnecessary during the ini-
because prostatic massage increases the risk of bactere- tial evaluation, but may help when the diagnosis remains
mia, and subsequently, sepsis. unclear or when patients do not respond to adequate
antibiotic therapy. Patients who remain febrile after 36
PROGNOSTIC FACTORS hours or whose symptoms do not improve with antibiotics
A 2014 study of patients with acute bacterial prostati- should undergo transrectal ultrasonography to evaluate
tis identified age older than 65 years, body temperature for prostatic abscess. Alternatively, noncontrast computed
greater than 100.4°F (38°C), benign prostatic hypertro- tomography (CT) or magnetic resonance imaging (MRI)
phy, urinary retention, and transurethral catheteriza- of the pelvis could be considered. Prostate biopsy should
tion as factors associated with poor outcomes.23 These not be performed to avoid inducing septicemia.
outcomes included septic shock, positive blood culture,
and prostatic abscess.23 In patients with any of these fac- Management
tors, the physician should strongly consider ordering a Management of acute bacterial prostatitis should be
complete blood count and a basic metabolic panel. In the based on severity of symptoms, risk factors, and local
same study, a white blood cell count greater than 18,000 antibiotic resistance patterns (Figure 1). Most patients
per mm3 (18 × 109 per L) and a blood urea nitrogen level can be treated with outpatient antibiotics; fewer than
greater than 19 mg per dL (6.8 mmol per L) were inde- one in six patients will require hospitalization.6 Admis-
pendently associated with severe cases of acute bacterial sion criteria are listed in Table 4.
prostatitis. Inflammatory markers, such as C-reactive Initial empiric antibiotic therapy should be based
protein and erythrocyte sedimentation rate, will likely on the suspected mode of infection and the presumed

116  American Family Physician www.aafp.org/afp Volume 93, Number 2 ◆ January 15, 2016
 Acute Bacterial Prostatitis
Table 4. Admission Criteria for Acute Bacterial
Prostatitis

Failed outpatient management

infecting organism (Table 5).5,7-9,15-17,24,25 Antibiotics Inability to tolerate oral intake
should be adjusted based on culture and sensitivity Resistance risk factors
results, when available.10,15 Men younger than 35 years Recent fluoroquinolone use
who are sexually active and men older than 35 years Recent transurethral or transrectal prostatic manipulation
who engage in high-risk sexual behavior should be Systemically ill or septicemia
treated with regimens that cover N. gonorrhoeae Urinary retention
and C. trachomatis.12 Patients with risk factors for

Management of Acute Bacterial Prostatitis

History and physical examination

Order urinalysis and urine cultures for all

patients plus postvoid residual measurement
if urinary obstruction suspected
Consider admission criteria (Table 4)

Outpatient management Inpatient management

Consider blood cultures

At risk for sexually

transmitted infections?

Not severely ill and no Severely ill and no Any severity and
resistance risk factors resistance risk factors resistance risk factors
Yes No

Antibiotic Antibiotic
group A group B Antibiotic group C (Table 5) Antibiotic group D (Table 5) Antibiotic group E (Table 5)
(Table 5) (Table 5)

Fever persists more than 36 hours?

Adjust antibiotics based on culture results
If symptoms persist after 2 weeks,
reorder culture and extend antibiotic Yes No
therapy for another 2 weeks
Transrectal ultrasonography (noncontrast
CT or MRI of the pelvis are alternatives)

Abscess?

Yes No

Urology consultation Broaden antibiotic coverage

for drainage Consider broadening differential diagnosis and
obtaining additional blood and urine cultures

Adjust antibiotics based on culture results

Transition to oral regimen when patient is stable

Treat for another 2 to 4 weeks with oral antibiotics
Repeat urine culture 1 week after cessation of antibiotics

Figure 1. Management of acute bacterial prostatitis. (CT = computed tomography; MRI = magnetic resonance imaging.)
Acute Bacterial Prostatitis

antibiotic resistance require intravenous therapy with The duration of antibiotic therapy for mild infections
broad-spectrum regimens because of the high likeli- is typically 10 to 14 days (with a two-week extension if the
hood of complications.7,8,15,24 patient remains symptomatic), or four weeks for severe

Table 5. Antibiotic Regimens for Acute Bacterial Prostatitis

Group Primary regimen Alternative regimen

A Single dose of ceftriaxone (Rocephin), 250 mg intramuscularly, or —

single dose of cefixime (Suprax), 400 mg orally
then
Doxycycline, 100 mg orally twice daily for 10 days

B Ciprofloxacin, 500 mg orally twice daily for 10 to 14 days Trimethoprim/sulfamethoxazole, 160/800 mg orally twice
or daily for 10 to 14 days
Levofloxacin (Levaquin), 500 to 750 mg orally daily for 10 to 14 days

C Ciprofloxacin, 400 mg IV every 12 hours Ceftriaxone, 1 to 2 g IV every 24 hours

or plus
Levofloxacin, 500 to 750 mg IV every 24 hours Levofloxacin, 500 to 750 mg IV every 24 hours
or
Piperacillin/tazobactam (Zosyn), 3.375 g IV every 6 hours

D Piperacillin/tazobactam, 3.375 g IV every 6 hours plus Fluoroquinolone (group C)

aminoglycosides* plus
or Aminoglycosides*
Cefotaxime (Claforan), 2 g IV every 4 hours plus aminoglycosides* or
or Ertapenem (Invanz), 1 g IV every 24 hours
Ceftazidime (Fortaz), 2 g IV every 8 hours plus aminoglycosides* or
Imipenem/cilastatin (Primaxin), 500 mg IV every 6 hours
or
Meropenem (Merrem IV), 500 mg IV every 8 hours

E Transrectal manipulation—fluoroquinolone resistance

and extended spectrum beta-lactamase–producing
Escherichia coli
Piperacillin/tazobactam, 3.375 g IV every 6 hours plus Ertapenem, 1 g IV every 24 hours
aminoglycosides* or
Imipenem/cilastatin, 500 mg IV every 6 hours
Transurethral manipulation—Pseudomonas species
Piperacillin/tazobactam, 3.375 g IV every 6 hours† Fluoroquinolone (group C)†
or or
Ceftazidime, 2 g IV every 8 hours† Imipenem/cilastatin, 500 mg IV every 6 hours
or or
Cefipime, 2 g IV every 12 hours† Meropenem, 500 mg IV every 8 hours
Fluoroquinolone exposure—fluoroquinolone resistance
Piperacillin/tazobactam, 3.375 g IV every 6 hours† Ceftriaxone, 1 g IV every 24 hours†
or or
Ceftazidime, 2 g IV every 8 hours† Ertapenem, 1 g IV every 24 hours
or
Cefepime, 2 g IV every 12 hours†

IV = intravenously.
*—Dosing instructions: gentamicin, 7 mg per kg IV every 24 hours, peak 16 to 24 mcg per mL, trough less than 1 mcg per mL; amikacin, 15 mg per kg IV
every 24 hours, peak 56 to 64 mcg per mL, trough less than 1 mcg per mL.
†—Aminoglycosides should be added to regimen if patient is clinically unstable.
Information from references 5, 7 through 9, 15 through 17, 24, and 25.

118  American Family Physician www.aafp.org/afp Volume 93, Number 2 ◆ January 15, 2016
 Acute Bacterial Prostatitis

infections.9,26 Febrile patients should generally become CT, or MRI is required to rule out prostatic abscess.27
afebrile within 36 hours of starting antibiotic therapy.27 After severe infections improve and the patient is afebrile,
Otherwise, imaging with transrectal ultrasonography, antibiotics should be transitioned to oral form and
continued for another two to four weeks.5,28 Repeat urine
cultures should be obtained one week after cessation of
antibiotics to ensure bacterial clearance.12
Supportive measures include providing antipyretics,
Considerations hydrating fluids, and pain control. Acute urinary reten-
Regimen covers Neisseria gonorrhoeae and Chlamydia trachomatis tion occurs in approximately one in 10 patients with
infections in addition to other common bacterial pathogens acute bacterial prostatitis. Relieving urinary obstruction
is an important treatment consideration in clearing the
infection and providing pain relief.6 However, the best
Extend treatment for 2 weeks if patient remains symptomatic approach to this intervention has not been determined.
Cystostomy provides good relief and may prevent chronic
infection, but urethral catheterization is an easier option
Continue treatment until patient is afebrile, then transition to oral for relieving obstruction.29
regimen (group B) for an additional 2 to 4 weeks
Complications
Prostatic abscesses occur in 2.7% of patients with acute
bacterial prostatitis and require urology consultation for
Continue treatment until patient is afebrile, then transition to oral drainage.6 Risk factors for prostatic abscess include long-
regimen (group B) for an additional 2 to 4 weeks term urinary catheterization, recent urethral manipula-
tion, and an immunocompromised state.
Approximately 13% of patients with acute bacterial
prostatitis experience recurrence necessitating a longer
course of antibiotics.6 Patients with persistent or recur-
rent symptoms should have a repeat urine culture to
evaluate for repeat bacterial prostatitis and be treated
based on culture results. After three months of persistent
Continue treatment until patient is afebrile, then transition to oral
regimen (group B) for an additional 2 to 4 weeks
or recurrent symptoms, patients should be evaluated and
Carbapenems can be used if patient is unstable treated based on chronic prostate syndrome guidelines.1
If patient is stable, follow primary regimen while awaiting culture Approximately one in nine patients with acute bacterial
results prostatitis will develop chronic bacterial prostatitis or
chronic pelvic pain syndrome.29

Prevention
Although there are no known strategies for preventing
community-acquired acute bacterial prostatitis, nosoco-
mial infections can be reduced by avoiding unnecessary
manipulation of the prostate, such as transrectal biopsy
or urethral catheterization. Administering antibiotics
before transrectal prostate biopsies reduces postopera-
tive complications such as urinary tract infections, acute
prostatitis, bacteriuria, and bacteremia; new approaches
to prevention are needed to reduce fluoroquinolone
resistance and extended spectrum beta-lactamase–
producing E. coli infections.13,14 A 500-mg oral dose of
ciprofloxacin 12 hours before transrectal prostate biopsy
with a repeat dose at the time of biopsy is the typical pro-
phylactic regimen.25 Preoperative enemas do not reduce
infection rates.24 In patients who are at increased risk of

January 15, 2016 ◆ Volume 93, Number 2 www.aafp.org/afp American Family Physician 119
Acute Bacterial Prostatitis

harboring fluoroquinolone-resistant bacteria, preopera- 10. Nagy V, Kubej D. Acute bacterial prostatitis in humans: current micro-
biological spectrum, sensitivity to antibiotics and clinical findings. Urol
tive stool cultures may allow for tailoring of antibiotics Int. 2012;89(4):445-450.
at the time of the procedure.17,30 11. Ramakrishnan K, Salinas RC. Prostatitis: acute and chronic. Prim Care.
2010;37(3):547-563, viii-ix.
Data Sources: A PubMed search was completed in Clinical Queries
using the keywords acute prostatitis, title words acute prostatitis, and 12. Brede CM, Shoskes DA. The etiology and management of acute prosta-
prostatitis [MeSH] AND acute. The search included meta-analyses, titis. Nat Rev Urol. 2011;8(4):207-212.
randomized controlled trials, clinical trials, and reviews. Also searched 13. Zani EL, Clark OA, Rodrigues Netto N Jr. Antibiotic prophylaxis for

were the Agency for Healthcare Research and Quality evidence reports, transrectal prostate biopsy. Cochrane Database Syst Rev. 2011;
Cochrane Database of Systematic Reviews, National Guideline Clearing- (5):CD006576.
house, Essential Evidence Plus, and UpToDate. Search Dates: November 14. Campeggi A, Ouzaid I, Xylinas E, et al. Acute bacterial prostatitis after
19, 2014, and October 20, 2015. transrectal ultrasound-guided prostate biopsy: epidemiological, bacte-
ria and treatment patterns from a 4-year prospective study. Int J Urol.
The opinions and assertions contained herein are the private views of the 2014;21(2):152-155.
authors and are not to be construed as official or as reflecting the views 15. Özden E, Bostanci Y, Yakupoglu KY, et al. Incidence of acute prostatitis
of the U.S. Air Force Medical Department or the U.S. Air Force at large. caused by extended-spectrum beta-lactamase-producing Escherichia
coli after transrectal prostate biopsy. Urology. 2009;74(1):119-123.
16. Ekici S, Cengiz M, Turan G, Alış EE. Fluoroquinolone-resistant acute
The Authors prostatitis requiring hospitalization after transrectal prostate biopsy:
TIMOTHY J. COKER, MD, FAAFP, is associate program director at the effect of previous fluoroquinolone use as prophylaxis or long-term
Ehrling Bergquist Family Medicine Residency Program, Offutt Air Force treatment. Int Urol Nephrol. 2012;44(1):19-27.
Base, Neb. He is also an assistant professor at the Uniformed Services 17. Minamida S, Satoh T, Tabata K, et al. Prevalence of fluoroquinolone-
University of the Health Sciences, Bethesda, Md. resistant Escherichia coli before and incidence of acute bacterial prosta-
titis after prostate biopsy. Urology. 2011;78(6):1235-1239.
DANIEL M. DIERFELDT, DO, is an assistant professor at the Uniformed Ser- 18. Song W, Choo SH, Sung HH, et al. Incidence and management of

vices University of the Health Sciences. He is also an attending physician at extended-spectrum beta-lactamase and quinolone-resistant Escherichia
the Offutt Family Medicine Residency, Offutt Air Force Base, Neb. coli infections after prostate biopsy. Urology. 2014;84(5):1001-1007.

Address correspondence to Timothy J. Coker, MD, Ehrling Bergquist 19. Ludwig M. Diagnosis and therapy of acute prostatitis, epididymitis and
orchitis. Andrologia. 2008;40(2):76-80.
Family Medicine Residency Program, 2501 Capehart Rd., Offutt Air
Force Base, NE 68113 (e-mail: [email protected]). Reprints are not 20. Touma NJ, Nickel JC. Prostatitis and chronic pelvic pain syndrome in
available from the authors. men. Med Clin North Am. 2011;95(1):75-86.
21. Etienne M, Pestel-Caron M, Chapuzet C, Bourgeois I, Chavanet P, Caron
F. Should blood cultures be performed for patients with acute prostati-
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120  American Family Physician www.aafp.org/afp Volume 93, Number 2 ◆ January 15, 2016