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Acute Bacterial ProstatitisAka: Acute Prostatitis

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  1. Epidemiology
    1. Rare type of Prostatitis
    2. Usually seen in younger men
  2. Pathophysiology
    1. Mechanisms
      1. Ascending infection from infected urethra
      2. Direct or lymphatic spread from rectum
      3. Hematogenous spread
    2. Organisms
      1. Aerobic Gram Negative Rods (Enterobacteriaceae)
        1. Escherichia coli (80%)
        2. Klebsiella
      2. Gram Positive Bacteria
        1. Streptococcus faecalis
        2. Staphylococcus aureus
      3. Pseudomonas (hospitalized patients)
  3. Risk factors
    1. Urinary Tract Infections
      1. Indwelling urethral catheter
      2. Condom Catheter Drainage
    2. Infected sexual contact
  4. Symptoms (sudden onset)
    1. Systemic symptoms
      1. Fever and chills
      2. Malaise
      3. Joint pain (arthralgia)
      4. Muscle pain (myalgia)
    2. Referred pain
      1. Low pack pain
      2. Perineal pain
    3. Irritative urinary symptoms
      1. Dysuria
      2. Urinary frequency
      3. Urinary urgency
    4. Obstructive urinary symptoms
      1. Decreased urine caliber and force
      2. Urinary hesitancy
      3. Postvoid dribbling
      4. Incomplete bladder emptying sensation
      5. Urine retention
  5. Signs
    1. Digital Rectal Exam contraindicated
      1. Risk of bacteremia
      2. Prostate would be warm, boggy, tender on palpation
  6. Differential Diagnosis
    1. See Prostatitis
  7. Labs
    1. Urine Culture
  8. Radiology: Evaluation of source
    1. Renal Ultrasound
    2. Abdominal XRay
  9. Indications for Hospitalization
    1. Urinary Retention
    2. Requirement for parenteral antibiotics
      1. Signs of bacteremia (fever, rigors)
    3. Significant Dehydration
  10. Management: Outpatient Antibiotics
    1. See Prostatitis General Measures
    2. Age under 35 years old (Gonorrhea and Chlamydia)
      1. Ofloxacin 400 mg po, then 300 mg PO bid for 10 days
      2. Combined regimen
        1. Ceftriaxone 250 mg IM and
        2. Doxycycline 100 mg bid for 10 days
    3. Age over 35 years old (Enterobacteriaceae)
      1. Levofloxacin 500 mg PO qd for 14 days
        1. Excellent first-line agent
      2. Ofloxacin 200 mg PO bid for 14 days
      3. Ciprofloxacin 500 mg PO bid for 14 days
        1. Reserve for Pseudomonas and Enterococcus cases
      4. Trimethoprim Sulfamethoxazole DS PO bid for 14 days
  11. Complications
    1. Chronic Prostatitis (if inadequate therapy duration)
    2. Pyelonephritis
    3. Epididymitis
    4. Prostatic abscess
    5. Sepsis
  12. References
    1. Cooner (1994) Prostate Disease, AAFP, p. 9-15
    2. Gilbert (2000) Sanford Guide, p. 18-9
    3. Krieger (Summer, 1998) Patient Care Suppl.: Prostatitis
    4. Schwager (1991) Am Fam Physician 44(6):2137

Acute prostatitis (C0149524)

ConceptsDisease or Syndrome (T047)
ICD9601.0
EnglishAcute Prostatitis
Spanishprostatitis aguda
Parent Conceptsprostatitis (C0033581), Acute inflammatory disease (C1290885), Duplicate concept (C1274013)
SourcesDXP, ICD9CM, NCI, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Acute Bacterial Prostatitis (C1720795)

ConceptsDisease or Syndrome (T047)
MSHD011472
EnglishAcute Bacterial Prostatitides, Acute Bacterial Prostatitis
SourcesMSH
Derived from the NIH UMLS (Unified Medical Language System)



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