What are the guideline sources, guidelines and references for Acute bacterial prostatitis ?
Guideline sources The following summarized guidelines for the evaluation and management of acute bacterial prostatitis are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2022) and the Canadian Urological Association (CUA 2011). 1 2 Guidelines 1. Diagnostic investigations Physical examination: As per EAU 2022 guidelines, do not perform prostatic massage in patients with acute bacterial prostatitis. D As per CUA 2011 guidelines, perform a physical examination (including the abdomen, external genitalia, perineum, and prostate) in patients with suspected acute bacterial prostatitis. Do not perform prostatic massage during DRE. B Urine tests: As per EAU 2022 guidelines: Obtain a midstream urine dipstick to check nitrites and WBCs in patients with clinical suspicion of acute bacterial prostatitis. B https://web.pathway.md/diseases/reczV9TLWSsc4JYIy 1/3 6/23/23, 1:42 AM Acute bacterial prostatitis Pathway Obtain a midstream urine culture in patients with symptoms of acute bacterial prostatitis to guide diagnosis and tailor antibiotic therapy. B As per CUA 2011 guidelines, obtain a urinalysis and urine culture in patients with suspected acute bacterial prostatitis. B Blood tests: As per EAU 2022 guidelines, obtain a CBC and blood culture in patients presenting with acute bacterial prostatitis. B As per CUA 2011 guidelines, do not obtain serum prostate-specific antigen in patients with acute bacterial prostatitis as elevated levels of prostate-specific antigen associated with acute bacterial prostatitis usually leads to confusion and worry. D Transrectal ultrasound: As per EAU 2022 guidelines, obtain transrectal ultrasound in selected cases to rule out the presence of prostatic abscess. B As per CUA 2011 guidelines, consider obtaining transrectal prostatic ultrasound or CT to rule out prostatic abscess/pathology in patients with acute bacterial prostatitis refractory to initial therapy. B Pelvic imaging: consider obtaining pelvic ultrasound or bladder scan in patients with acute bacterial prostatitis with severe obstructive symptoms, poor bladder emptying, or physical examination findings of possible urinary retention. C 2. Medical management General principles: treat acute bacterial prostatitis according to the recommendations for complicated UTIs. C Setting of care: admit patients to hospital in case of fever, prolonged vomiting, severe dehydration, tachycardia, tachypnea, hypotension, and other symptoms related to urosepsis, as well as high-risk patients (diabetes, immunosuppression, older age, or prostatic abscess) and patients with severe voiding disorders. B Antibiotic therapy: Administer IV high-dose aminoglycosides in combination with ampicillin, a broad spectrum penicillin in combination with a -lactamase inhibitor, a third-generation cephalosporin, or a fluoroquinolone in patients with severe symptomatic febrile acute bacterial prostatitis until defeverescence and normalization of associated urosepsis. B . Switch to outpatient oral fluoroquinolones for 2-4 weeks following resolution of severe infection and for less severely ill patients. B Consider administering oral fluoroquinolones for 2-4 weeks in non-severely ill patients. C Management of pain: administer nonsteroidal anti-inflammatory agents for symptom relief including fever. https://web.pathway.md/diseases/reczV9TLWSsc4JYIy 2/3 6/23/23, 1:43 AM Acute bacterial prostatitis Pathway Management of voiding symptoms: consider administering alpha-blockers to reduce the risk of urinary retention and facilitate micturition, particularly in patients with moderately severe obstructive voiding symptoms. 3. Therapeutic procedures Urethral catheterization: Perform urethral catheterization with a trial of voiding or short-term small caliber urethral catheterization in patients with severe obstructive voiding symptoms or urinary retention. B Consider placing a suprapubic tube in patients not tolerating a urethral catheter. C 4. Surgical interventions Drainage of prostatic abscess: perform incision and drainage of the prostatic abscess, preferably via transurethral route. B References 1. J Curtis Nickel. Prostatitis. Can Urol Assoc J. 2011 Oct;5 5 306 15. Open 2. G. Bonkat, R. Bartoletti, F. Bruy re et al. EAU Guidelines on Urological Infections. EAU. 2022. Open 3. Jerneja Vide nik Zorman, Mojca Mati i , Samo Jeverica et al. Diagnosis and treatment of bacterial prostatitis. Acta Dermatovenerol Alp Pannonica Adriat. 2015;24 2 25 9. Open https://web.pathway.md/diseases/reczV9TLWSsc4JYIy 3/3