People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off‑label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.
Be aware that acute prostatitis:
is a bacterial infection of the prostate needing treatment with antibiotics
is usually caused by bacteria entering the prostate from the urinary tract
can occur spontaneously or after medical procedures such as prostate biopsy
can last several weeks
can cause complications such as acute urinary retention and prostatic abscess.
Offer an antibiotic (see the recommendations on choice of antibiotic) to people with acute prostatitis. Take account of:
the severity of symptoms
the risk of developing complications or having treatment failure, particularly after medical procedures such as prostate biopsy
previous urine culture and susceptibility results
previous antibiotic use, which may have led to resistant bacteria.
Obtain a midstream urine sample before antibiotics are taken and send for culture and susceptibility testing.
When results of urine cultures are available:
review the choice of antibiotic, and
change the antibiotic according to susceptibility results if the bacteria are resistant, using a narrow spectrum antibiotic wherever possible.
When an antibiotic is given, give advice about:
the usual course of acute prostatitis (several weeks)
possible adverse effects of the antibiotic, particularly diarrhoea and nausea
seeking medical help if:
symptoms worsen at any time, or
symptoms do not start to improve within 48 hours of taking the antibiotic, or
the person becomes systemically very unwell.
Reassess if symptoms worsen at any time, taking account of:
other possible diagnoses
any symptoms or signs suggesting a more serious illness or condition, such as acute urinary retention, prostatic abscess or sepsis
previous antibiotic use, which may have led to resistant bacteria.
Refer people with acute prostatitis to hospital if:
they have any symptoms or signs suggesting a more serious illness or condition (for example sepsis, acute urinary retention or prostatic abscess), or
their symptoms are not improving 48 hours after starting the antibiotic.
For a short explanation of why the committee made these recommendations, see the evidence and committee discussion on antibiotics.
Full details of the evidence and the committee's discussion are in the evidence review.
Advise people with acute prostatitis about using paracetamol (with or without a low‑dose weak opioid, such as codeine) for pain, or ibuprofen if this is preferred and suitable.
Advise people with acute prostatitis about drinking enough fluids to avoid dehydration.
For a short explanation of why the committee made these recommendations, see the evidence and committee discussion on self-care.
Full details of the evidence and the committee's discussion are in the evidence review.
When prescribing an antibiotic for acute prostatitis, take account of local antimicrobial resistance (AMR) data from Public Health England and follow table 1 for adults aged 18 years and over.
Give oral antibiotics first line if the person can take oral medicines, and the severity of their condition does not require intravenous antibiotics.
Review intravenous antibiotics by 48 hours and consider stepping down to oral antibiotics where possible.
Review antibiotic treatment after 14 days and either stop the antibiotic or continue for a further 14 days if needed, based on an assessment of the person's history, symptoms, clinical examination, urine and blood tests.
| Treatment | Antibiotic, dosage and course length |
|---|---|
|
First-choice oral antibiotics (guided by susceptibilities when available) |
Ciprofloxacin: 500 mg twice a day for 14 days then review Ofloxacin: 200 mg twice a day for 14 days then review See the MHRA January 2024 advice on restrictions and precautions for using fluoroquinolone antibiotics because of the risk of disabling and potentially long‑lasting or irreversible side effects |
|
Alternative first-choice oral antibiotic if a fluoroquinolone antibiotic is not appropriate (seek specialist advice; guided by susceptibilities when available) |
Trimethoprim: 200 mg twice a day for 14 days then review |
|
Second-choice oral antibiotics (after discussion with specialist) |
Levofloxacin: 500 mg once a day for 14 days then review See the MHRA January 2024 advice on restrictions and precautions for using fluoroquinolone antibiotics because of the risk of disabling and potentially long‑lasting or irreversible side effects Co‑trimoxazole: 960 mg twice day for 14 days then review Co-trimoxazole should only be considered when there is bacteriological evidence of sensitivity and good reasons to prefer this combination to a single antibiotic (BNF information on co\u2011\trimoxazole) |
|
First-choice intravenous antibiotics (if unable to take oral antibiotics or severely unwell; guided by susceptibilities when available). Antibiotics may be combined if sepsis a concern |
Ciprofloxacin: 400 mg twice or three times a day Levofloxacin: 500 mg once a day See the MHRA January 2024 advice on restrictions and precautions for using fluoroquinolone antibiotics because of the risk of disabling and potentially long‑lasting or irreversible side effects Cefuroxime: 1.5 g three or four times a day Ceftriaxone: 2 g once a day Gentamicin: Initially 5 mg/kg to 7 mg/kg once a day, subsequent doses adjusted according to serum gentamicin concentration Therapeutic drug monitoring and assessment of renal function is required (BNF information on gentamicin) Amikacin: Initially 15 mg/kg once a day (maximum per dose 1.5 g once a day), subsequent doses adjusted according to serum amikacin concentration (maximum 15 g per course) Therapeutic drug monitoring and assessment of renal function is required (BNF information on amikacin) |
|
Second-choice intravenous antibiotics |
Consult a local microbiologist |
See the BNF for appropriate use and dosing in specific populations, for example, hepatic impairment and renal impairment, and administering intravenous antibiotics.
Check any previous urine culture and susceptibility results and antibiotic prescribing and choose antibiotics accordingly.
Review treatment after 14 days and either stop the antibiotic or continue for a further 14 days if needed based on clinical assessment.
Review intravenous antibiotics by 48 hours and consider stepping down to oral antibiotics where possible for a total of 14 days then review.
For a short explanation of why the committee made these recommendations, see the evidence and committee discussion on choice of antibiotic.
Full details of the evidence and the committee's discussion are in the evidence review.