A 59-year-old male presents to the emergency department complaining of fever, chills and dysuria for the past 24 hours. Past medical history is significant for hypothyroidism, hypertension and obesity. Vital signs reveal a temperature of 38.4°C (101.2°F), blood pressure of 146/79mm/Hg, heart rate 92/min, respiratory rate of 18/min, and an oxygen saturation of 96% on room air. Physical examination reveals normal external genitalia, non-tender testes, and an exquisitely tender prostate on rectal exam. The most appropriate management is
- amoxicillin-clavulanate
- ampicillin
- ceftriaxone plus doxycycline
- nitrofurantoin
- trimethoprim-sulfamethoxazole
trimethoprim-sulfamethoxazole
This patient is presenting with acute bacterial prostatitis.
In approximately 80% of cases, the causative organism is Escherichia coli.
The remainders of the cases are caused by Klebsiella, Enterobacter, Proteus and Pseudomonas species.
The acutely inflamed prostate can cause fevers, rigors, dysuria, bacteriuria and a tense, tender prostate on exam.
Voiding urgency and bladder outlet obstruction or retention is also common.
Acute bacterial prostatitis is usually spontaneous but has been known to occur due to indwelling Foley catheters.
First-line agents in the treatment of acute prostatitis are trimethoprim-sulfamethoxazole or a fluoroquinolone such as ciprofloxacin.
Alternative antibiotics include ampicillin with gentamicin.
Chronic prostatitis is less frequent and is more difficult to treat than the acute infection of the prostate.
Chronic prostatitis is usually associated with low back pain or perineal pain.
Rarely, some cases of prostatitis can lead to a prostatic abscess.
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