Management of bacterial prostatitis: what's new?

Prostatitis is a common healthcare issue affecting 10-14% of men of all ages and ethnicities. Acute bacterial prostatitis is associated with severe, mainly Gram-negative infection; treatment consists of broad-spectrum antibiotic therapy for 2-4 weeks, which can be tailored according to pathogen identification and susceptibility tests. Chronic bacterial prostatitis is more difficult to diagnose as the symptoms are shared by chronic pelvic pain syndrome; only 10% of patients with chronic prostatitis symptoms actually have bacterial infection. The pathogens associated with this condition are essentially common uropathogens, although there is debate around the role of Gram-positive bacteria. Definitive diagnosis is obtained with the Meares-Stamey four-glass test, or the two-glass test in routine practice, which differentiates between chronic bacterial prostatitis and chronic pelvic pain syndrome. The fluoroquinolones are the first choice of therapy for chronic bacterial prostatitis, in particular levofloxacin which is as effective as ciprofloxacin but shows a better prostatic penetration and is given once daily.