title: The role of antibiotics in the treatment of chronic prostatitis: a consensus statement.
abstract: Practical guidelines for the diagnosis and treatment of chronic prostatitis are presented. Chronic prostatitis is classified as chronic bacterial prostatitis (culture-positive) and chronic inflammatory prostatitis (culture-negative). If chronic bacterial prostatitis is suspected, based on relevant symptoms or recurrent UTIs, underlying urological conditions should be excluded by the following tests: rectal examination, midstream urine culture and residual urine. The diagnosis should be confirmed by the Meares and Stamey technique. Antibiotic therapy is recommended for acute exacerbations of chronic prostatitis, chronic bacterial prostatitis and chronic inflammatory prostatitis, if there is clinical, bacteriological or supporting immunological evidence of prostate infection. Unless a patient presents with fever, antibiotic treatment should not be initiated immediately except in cases of acute prostatitis or acute episodes in a patient with chronic bacterial prostatitis. The work-up, with the appropriate investigations should be done first, within a reasonable time period which, preferably, should not be longer than 1 week. During this period, nonspecific treatment, such as appropriate analgesia to relieve symptoms, should be given. The minimum duration of antibiotic treatment should be 2-4 weeks. If there is no improvement in symptoms, treatment should be stopped and reconsidered. However, if there is improvement, it should be continued for at least a further 2-4 weeks to achieve clinical cure and, hopefully, eradication of the causative pathogen. Antibiotic treatment should not be given for 6-8 weeks without an appraisal of its effectiveness. Currently used antibiotics are reviewed. Of these, the fluoroquinolones ofloxacin and ciprofloxacin are recommended because of their favourable antibacterial spectrum and pharmacokinetic profile. A number of clinical trials are recommended and a standard study design is proposed to help resolve some outstanding issues.
authors.affiliation: Section of Urology, Norwegian Institute of Urology, University of Tromso, Porsgrunn, Norway. truls.bjerklund-johansen@tss.telemax.no
authors.forename: T E
authors.initials: TE
authors.lastname: Bjerklund Johansen
authors.forename: R N
authors.initials: RN
authors.lastname: Grüneberg
authors.forename: J
authors.initials: J
authors.lastname: Guibert
authors.forename: A
authors.initials: A
authors.lastname: Hofstetter
authors.forename: B
authors.initials: B
authors.lastname: Lobel
authors.forename: K G
authors.initials: KG
authors.lastname: Naber
authors.forename: J
authors.initials: J
authors.lastname: Palou Redorta
authors.forename: P J
authors.initials: PJ
authors.lastname: van Cangh
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D002908:Chronic Disease; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011472:Prostatitis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents