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What is the best antibiotic to treat prostatitis?

Oral antimicrobial agents are the mainstay of treatment for chronic bacterial prostatitis (CBP), with the most effective medications being fluoroquinolones and trimethoprim-sulfamethoxazole (TMP/SMX).

emedicine.medscape.com - Chronic Bacterial Prostatitis Medication - Medscape Reference

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Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting. Fluoroquinolones are frequently used because they are able to concentrate in the prostate and are lipid soluble. Sulfonamides are also used, because they are lipid soluble. Since 2008 the FDA has issued a Black Box warning regarding the long-term use of fluoroquinolones. There is a risk of tendonitis and tendon rupture that may cause long-term and possibly permanent damage. The occurence is about 1 in 100,000, about 4 times the normal risk. The risk is greatest for the Achilles tendons, but shoulder and hand tendon ruptures also have been reported. Ciprofloxacin is a fluoroquinolone with activity against pseudomonas, streptococci, MRSA, Streptococcus epidermidis, and most gram-negative organisms, but with no activity against anaerobes. It inhibits bacterial DNA synthesis and, consequently, growth. Moxifloxacin is a quinolone that has antimicrobial activity based on its ability to inhibit bacterial deoxyribonucleic acid (DNA) gyrase and topoisomerases, which are required for replication, transcription, and translation of genetic material. Quinolones have broad activity against gram-positive and gram-negative aerobic organisms. Differences in chemical structure between quinolones have resulted in altered levels of activity against different bacteria. Altered chemistry in quinolones results in toxicity differences. TMP/SMX inhibits bacterial growth by inhibiting the synthesis of dihydrofolic acid. It has good penetration into the prostate and activity against most relevant organisms. It has no acitivity against Pseudomonas. Ofloxacin penetrates the prostate well and is effective against Neisseria gonorrhea and C trachomatis. It is a derivative of pyridine carboxylic acid with broad-spectrum bactericidal effects. Doxycycline inhibits protein synthesis and, thus, bacterial growth by binding to 30S and, possibly, 50S ribosomal subunits of susceptible bacteria. It has good activity against Chlamydia and Mycoplasma. It is contraindicated in renal and liver failure. Gentamicin is an aminoglycoside antibiotic for gram-negative coverage. It is used in combination with an agent against gram-positive organisms and one that covers anaerobes. It is not the drug of choice, but consider its use if other, less toxic drugs are contraindicated, when it is clinically indicated, and in mixed infections caused by susceptible staphylococci and gram-negative organisms. Levofloxacin is indicated for pseudomonal infections and for infections that are due to multidrug-resistant, gram-negative organisms.

Azithromycin

Good penetration into prostate. Covers Chlamydia and gram-positive bacteria but unreliable activity against gram-negative bacteria.

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Is there a blood test for prostatitis?

Prostatitis and PSA Prostate specific antigen (PSA) is a protein produced by the prostate. A PSA test is a simple blood test that measures the amount of PSA in your blood. You might be offered a PSA test if your GP is checking for other possible prostate problems, such as an enlarged prostate or prostate cancer.

prostatecanceruk.org - Prostatitis tests

Tests for chronic pelvic pain syndrome (CPPS)

There is no single test to diagnose CPPS. Your doctor will need to rule out other possible causes of your symptoms before they make a diagnosis. This can take some time. You might be diagnosed with CPPS if you’ve had some of the symptoms listed above for more than three of the last six months. But your doctor may diagnose CPPS sooner than this. They will ask you about your symptoms or give you a questionnaire to fill in. Your doctor may also ask about your medical history. This can help them work out what is causing your symptoms, and which treatments are most likely to help. You’ll need to have a urine test to make sure you don’t have a urine infection. You may also have a physical examination, including a digital rectal examination (DRE), and some other tests, such as a PSA test. Ask your doctor for more information about other tests you may have. For some tests, you might need to visit a doctor at the hospital who specialises in urinary problems (a urologist) or a specialist nurse.

Worried about having a DRE?

It’s natural to feel worried or embarrassed about having tests, but some men find the idea of having a DRE upsetting. For example, if you’ve ever been sexually abused, you might feel very upset about having this test. There’s no right or wrong way to feel, and it’s your choice whether or not to have a DRE. If you do decide to have a DRE, explain your situation to your doctor. They can talk you through the test and help to reassure you. It may also help to talk to a counsellor.

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