Which antibiotics are most effective in the treatment of prostatitis?

Updated: Aug 27, 2019
  • Author: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Nitrofurantoin, sulfonamides, vancomycin, penicillins, and cephalosporins do not penetrate well into the prostate.

Antibiotics that penetrate well into the acid milieu of the prostate are nonpolar and lipid-soluble and have a high measure of acid strength, a small molecular radius, and low serum protein binding. Drugs that best fit these criteria are the fluoroquinolones, doxycycline, minocycline (particularly effective against methicillin-resistant Staphylococcus aureus [MRSA]), trimethoprim (available in the United States only as trimethoprim-sulfamethoxazole [TMP-SMZ]), rifampin, and erythromycin. Of this group, the fluoroquinolones appear to achieve the best tissue levels.

Erythromycin is used as a second-line agent when culture results are available.


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