genitourinary disorders
Prostatitis
Treatment of Prostatitis
Treatment varies significantly with etiology Nontoxic patients can be treated at home with antibiotics, bed rest, analgesics, stool softeners, and hydration. Therapy with a fluoroquinolone (eg,ciprofloxacin500 mg orally twice a day orofloxacin300 mg orally twice a day) is usually effective and can be given until culture and sensitivity results are known. If the clinical response is satisfactory, treatment is continued for about 30 days to prevent chronic bacterial prostatitis. If sepsis is suspected, the patient is hospitalized and given broad-spectrum antibiotics IV (eg,ampicillinplusgentamicin). Antibiotics are started after the appropriate cultures are taken and continued until the bacterial sensitivity is known. If the clinical response is adequate, IV therapy is continued until the patient is afebrile for 24 to 48 hours, followed by oral therapy usually for 4 weeks. Adjunctive therapies include nonsteroidal anti-inflammatory drugs and potentially alpha-blockers (if bladder emptying is poor) and supportive measures such as sitz baths. Rarely, prostate abscess develops, requiring surgical drainage. Chronic bacterial prostatitis is treated with oral antibiotics such as fluoroquinolones for at least 6 weeks. Therapy is guided by culture results; empiric antibiotic treatment for patients with equivocal or negative culture results has a low success rate. Other treatments include anti-inflammatory drugs, muscle relaxants (eg,cyclobenzaprineto possibly relieve spasm of the pelvic muscles), alpha-adrenergic blockers, and other symptomatic measures, such as sitz baths. Treatment is difficult and often unrewarding. In addition to considering any and all of the above treatments, anxiolytics (eg, selective serotonin reuptake inhibitors [SSRIs], benzodiazepines), sacral nerve stimulation, biofeedback, prostatic massage, and minimally invasive prostatic procedures (such as microwave thermotherapy) have been attempted with varying results. Asymptomatic prostatitis requires no treatment. 