This handout is for prostatitis spectrum (nih i/ii/iiia/iiib/iv) — acute bacterial + chronic + cp/cpps. Your care team identified this based on: fever + perineal / pelvic / suprapubic pain + dysuria + tender enlarged prostate on dre — acute bacterial prostatitis nih i (krieger 1999 pmid 10422990).
Other reasons your team may use this plan: chronic pelvic / perineal pain ≥3 mo + luts ± ejaculatory pain — cp/cpps nih iii (schaeffer nejm 2006); recurrent uti in adult man with same organism — chronic bacterial prostatitis nih ii (eau 2013); acute febrile illness within 1–7 d of trus-bx → trus-bx-induced bacterial prostatitis (often fq-resistant e. coli) (liss aua 2014).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| ceftriaxone | 1–2 g IV q24h | IV | q24h × 24–72 h until afebrile + PO tolerance | EAU 2013 + Schaeffer 2006 — empiric IV pending culture; broad gram-negative coverage; PO step-down per culture (PMID 17050893) |
| ciprofloxacin | 500 mg PO BID (or 400 mg IV q12h if NPO) | PO/IV | BID × 4–6 wk total | FQ achieves excellent prostate tissue penetration; first-line PO step-down after IV ceftriaxone; 4–6 wk total to prevent chronic evolution (EAU 2013) |
| levofloxacin | 750 mg PO daily (or IV) | PO/IV | once daily × 4–6 wk total | FQ alternative with QD dosing; same prostate penetration profile |
| trimethoprim-sulfamethoxazole | 160/800 mg (DS) PO BID | PO | BID × 4–6 wk total | EAU 2013 alternative — good prostate penetration; only if susceptible per culture |
Plan: Prostatitis — NIH I/II/IIIa/IIIb/IV stratified regimen: acute IV→PO ceftriaxone+FQ × 4–6 wk; chronic FQ × 4–6 wk; CP/CPPS UPOINT multimodal; sepsis broad-spectrum + drainage; TRUS-bx FQ-resistant empirics
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Outpatient urology if non-responder or chronic recurrent; CP/CPPS multimodal team (urology + PT + pain + mental health); counsel return precautions in TRUS-bx context (EAU 2013; AUA 2019)
Guideline: Krieger NIH classification 1999 (I/II/IIIa/IIIb/IV) + Schaeffer NEJM 2006 chronic prostatitis review + EAU prostatitis 2013 + Aoun CP/CPPS multimodal 2017 + AUA chronic pelvic pain 2019 (UPOINT) + Liss TRUS-bx augmented prophylaxis AUA 2014 + FDA FQ Black Box 2016 + SCC 2026 sepsis bundle (urosepsis pathway)