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The three As of chronic prostatitis therapy: antibiotics, α‐blockers and anti‐inflammatories. What is the evidence?

Antibiotics are the most common first-line therapy for all the prostatitis syndromes [1,2], despite the consistent finding that only a 5% of these men have definite bacterial infection. Uncontrolled studies [9] suggested that antibiotics significantly improve the symptom complex associated with the very common diagnosis of CP/CPPS. A European consensus report concluded that a trial of antibiotic therapy for category IIIA inflammatory CPPS was justified, but not for category IIIB noninflammatory CPPS [10], although the recommendations were not based on strong evidence. This weak evidence and subsequent recommendations for antibiotic use in CP/ CPPS have significant ramifications for clinical practice.