Acute prostatitis

Acute bacterial prostatitis is an acute focal or diffuse suppurative inflammation of the prostate gland.

Acute prostatitis is a bacterial infection needing prompt treatment with antibiotics.

Gram-negative bacteria are the most common causative pathogens in acute prostatitis, most commonly (1)

• Escherichia coli,
• Proteus species,
• Klebsiella species and
• Pseudomonas species

A review states that acute bacterial prostatitis consists of a urinary tract infection (UTI) that includes infection of the prostate, typically associated with fever or chills and caused by gram-negative bacteria, such as Escherichia coli, Klebsiella, or Pseudomonas, in 80% to 97% of cases (2).

The prostate is usually involved as a consequence of:

• direct extension from the posterior urethra or urinary bladder
• distant spread in the blood or lymphatics

Occasionally, infection may spread from the rectum.

First-line therapy for acute prostatitis is broad-spectrum intravenous or oral antibiotics, such as intravenous piperacillin-tazobactam, ceftriaxone, or oral ciprofloxacin, which has a 92% to 97% success rate when prescribed for 2 to 4 weeks for people with febrile UTI and acute prostatitis (2).

Complications of acute prostatitis include:

• acute urinary retention secondary to prostatic oedema,
• chronic prostatitis,
• prostatic abscess,
• bacteraemia,
• epididymitis and
• pyelonephritis

Notes:

• in England, resistance of E. coli (the main causative organism of acute prostatitis) in laboratory processed urine specimens to the following antibiotics is (3):
  • ciprofloxacin: 10.6% (varies by area from 7.8% to 13.7%)
  • trimethoprim: 30.3% (varies by area from 27.1% to 33.4%) (Public Health England. Antimicrobial resistance quarterly surveillance: March 2018)

Reference:

1. Public Health England (October 2014). Management of infection guidance for primary care for consultation and local adaptation
2. Borgert BJ, Wallen EM, Pham MN. Prostatitis: A Review. JAMA. 2025;334(11):1003–1013.
3. NICE (October 2018).Prostatitis (acute): antimicrobial prescribing.