The following is the summary of  “How I manage bacterial prostatitis” published in the January 2023 issue of Clinical microbiology and infections by Lam, et al.

Bacterial prostatitis is a common infection that causes severe illness in males. Bacterial prostatitis continues to be difficult to diagnose and treat. The lack of high-quality information to aid a clinician’s interpretation of a patient’s history, physical examination, and test findings contributes to the difficulty of making an accurate diagnosis. In addition, the significant risk of recurrence makes treatment difficult, as do the small number of antimicrobials that can penetrate the prostate. In this study, researchers wanted to provide a helpful tool for doctors to use in the accurate diagnosis and treatment of both Acute Bacterial Prostatitis (ABP) and Chronic Bacterial Prostatitis (CBP).

 Without limiting our search by date, we combed through the encyclopedic database, PubMed, for articles on prostatitis. A clinical vignette is used to examine the causes, symptoms, diagnosis, and management of ABP and CBP. It is possible to identify bacterial prostatitis with the help of a detailed patient history and specific microbiological tests. If doubt persists about the diagnosis, the Meares-Stamey 4-glass test or modified 2-glass test can aid. While conventional uropathogens play a significant role in bacterial prostatitis, investigators are becoming increasingly interested in the potential contributions of atypical and classic non-pathogenic organisms. First-line treatment is still fluoroquinolones, and second-line treatment is trimethoprim-sulfamethoxazole (TMP-SMX) or doxycycline if the pathogen is sensitive to any of these antibiotics. 

Because of the rise in drug-resistant bacteria, fosfomycin has been given a new lease on life as a repurposed and effective agent. The host, the duration of symptoms, the susceptibility of uropathogens, the side effect profile of antimicrobials, and the existence of prostatic abscesses or calcifications all have a role in the difficulty of selecting effective antimicrobial regimens. ABP is usually treated in the same way as other severe forms of urinary tract infection. In contrast, CBP calls for extensive treatment lasting anywhere from 4 to 12 weeks.