The role of antibiotics in the treatment of chronic prostatitis: A consensus statement

Practical guidelines for the diagnosis and treatment of chronic prostatitis are presented. Chronic prostatitis is classified as chronic bacterial pros tatitis (culture-positive) and chronic inflammatory prostatitis (culture-ne gative). If chronic bacterial prostatitis is suspected, based on relevant s ymptoms or recurrent UTIs, underlying urological conditions should be exclu ded 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 ch ronic prostatitis, chronic bacterial prostatitis and chronic inflammatory p rostatitis, if there is clinical, bacteriological or supporting immunologic al evidence of prostate infection. Unless a patient presents with fever, an tibiotic treatment should not be initiated immediately except in cases of a cute prostatitis or acute episodes in a patient with chronic bacterial pros tatitis. The work-up, with the appropriate investigations should be done fi rst, within a reasonable time period which, preferably, should not be longe r than 1 week. During this period, nonspecific treatment, such as appropria te analgesia to relieve symptoms, should be given. The minimum duration of antibiotic treatment should be 2-4 weeks. If there is no improvement in sym ptoms, treatment should be stopped and reconsidered. However, if there is i mprovement, it should be continued for at least a further 2-4 weeks to achi eve clinical cure and, hopefully, eradication of the causative pathogen. An tibiotic treatment should not be given for 6-8 weeks without an appraisal o f its effectiveness. Currently used antibiotics are reviewed. Of these, the fluoroquinolones ofloxacin and ciprofloxacin are recommended because of th eir 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.