Acute Prostatitis and Epididymitis
Trimethoprim 200mg twice daily
OR ciprofloxacin 750mg twice daily(see BNF warnings and MHRA Drug Safety Alert)
Age 35 and under
Doxycycline 100mg twice daily
Age over 35 years
Cefalexin 500mg 3 times daily
OR trimethoprim 200mg twice daily
OR ciprofloxacin 750mg twice daily (see BNF warnings and MHRA Drug Safety Alert)
Send initial voided urine sample (first 5 to 10mL) to Virology for Chlamydial DNA strand amplification and MSU to bacteriology.
Consider semen culture.
4 weeks treatment may prevent chronic infection.
Age 35 years and under, likely to be sexually transmitted. Send urine samples to Virology and Microbiology as for bacterial prostatitis. If chlamydia isolated treat partner (see section on genital-tract infections).
Age over 35 years, common uropathogens responsible. Send MSU to bacteriology and treat according to sensitivities. Suitable agents with good tissue penetration include ciprofloxacin, trimethoprim and cefalexin. If recurrent, refer to Urology Outpatients.
The European Medicines Agency's Pharmacovigilance Risk Assessment Committee has recommended restricting the use of fluoroquinolone antibiotics following a review of disabling and potentially long-lasting side effects mainly involving muscles, tendons, bones and the nervous system (press release October 2018), but they are an option in acute pyelonephritis, which is a severe infection.
A lower risk of resistance may be more likely if not used in the past 3 months, previous urine culture suggests susceptibility (but this was not used), and in younger people in areas where local epidemiology data suggest resistance is low. A higher risk of resistance may be more likely with recent use and in older people in residential facilities.
For glossary of terms see Glossary