Prostatitis, chronic
- Refer to Urology
- Treat for 4-6 weeks
- Always check recent microbiology results for susceptibility results and treat accordingly.
- For diagnosis and differential diagnosis see Scenario: Managing chronic prostatitis | CKS | NICE
- For patients with penicillin allergy label consider penicillin allergy assessment and delabelling
Preferred
If symptoms present for less than 6 months:
trimethoprim 200mg po bd OR doxycycline 100mg po bd
If symptoms present for 6 months or more: Contact Micro/ID for advice
Alternative
Contact Micro/ID for advice
Treatment failure or Relapse
If suspected treatment failure: contact Micro/ID for advice. Treat according to culture and sensitivity.
If relapse: refer to Urology and contact Micro/ID for advice. Treat according to culture and sensitivity. Shorter courses, e.g. 5-7 days, may be recommended.
Additional Information
The European Association of Urology (EAU) Chronic Pelvic Pain guideline recommends a quinolone or tetracycline antibiotic in men with a duration of pelvic pain syndrome of less than one year. However, MHRA have issued Drug Safety Updates about serious side effects with fluoroquinolone antibiotics see Fluoroquinolone antibiotics - severe adverse effects for more information about these adverse effects. The EMA have also issued guidance about the side effects.
The recommendation in this guideline to offer trimethoprim or doxycycline as treatment options is based on consideration of possible side effects of fluoroquinolones and the alternatives to quinolones recommended in the UK consensus guideline:Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline.