Chronic bacterial prostatitis

(symptoms > 3 months)

- Subacute presentation – may have had prior acute bacterial prostatitis, or recurrent lower UTI symptoms and perineal discomfort.



- abdominal exam

- digital rectal prostate exam

- urinalysis and urine culture, urine for C. trachomatis and N. gonorrhoeae NAAT

- if lack of clinical improvement with culture-guided antibiotic therapy, consider transrectal US or CT to identify structural abnormalities, prostate calcifications, or prostatic abscess +/- urology referral. 


Usual Pathogens

Enterococcus spp
Pseudomonas aeruginosa


Staphylococcus spp
Streptococcus spp


Empiric Therapy Dose Duration
Ciprofloxacin 500-750mg PO bid 4 weeks
TMP/SMX 1 DS tab PO bid 6 weeks
Doxycycline 100mg PO bid 6 weeks


Failure of above agents, e.g. for MRSA, VRE, or ESBL or AmpC-producing E. coli 

Empiric Therapy Dose Duration
Fosfomycin 3 g PO daily x 1 week followed by 3 g every 2-3 days (depending on tolerance) x 5 weeks 6 weeks
  3 g PO every 2-3 days (depending on tolerance)