How is chronic bacterial prostatitis treated?

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

Although chronic bacterial prostatitis is very difficult to cure medically, an attempt should be made to cure this condition with antimicrobial therapy. [19, 20, 21, 22] Long-term results with TMP-SMZ (15-60% cure rate) probably reflect the inability of sulfa drugs to penetrate the noninflamed prostate; the usual regimen is 1 double-strength TMP-SMZ dose twice a day for 3 months.

The combination of TMP with rifampin may be useful but needs further study in chronic bacterial prostatitis. Some evidence suggests that 30 days of a fluoroquinolone may be superior to TMP-SMZ.

Coverage for Chlamydia and Ureaplasma should be considered for patients with category IIIA prostatitis (ie, leukocytosis without demonstrable bacteria).

If therapy fails, appropriate management of chronic bacterial prostatitis is to either treat acute exacerbations or to try chronic suppressive therapy (using half-normal doses).

Antimicrobials are not needed for asymptomatic patients who have evidence of inflammation on biopsy specimens or in secretions (category IV prostatitis); however, antimicrobials should be considered for men who are infertile who have bacteria or inflammation in their semen.


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