Pulse May 2019 issue - Page 38

38 Treatment of acute prostatitis in primary care An at-a-glance guide to NICE advice on a common treatment issue Send urine microscopy culture sensitivities (MCS) First-line antibiotics (all for 14 days)* • Ciprofl oxacin or • Ofl oxacin or • Trimethoprim if unable to take fl uoroquinolones** Advise return in 48 hours if no better, for hospital referral*** Routinely see after 14 days and reassess Consider continuing antibiotics for another 14 days, if needed *Check if previous urine sensitivity results available, and previous antibiotic prescribing (which may have led to resistant bacteria) to guide antibiotic choice ** Second-line oral antibiotic options (after discussion with specialist): • Levofloxacin for 14 days, then review – consider 14 more days treatment • Co-trimoxazole for 14 days, then review – consider 14 more days treatment (co-trimoxazole should only be considered when there is bacteriological evidence of sensitivity and good reasons to prefer this combination to a single antibiotic) *** Not improving after 48 hours of starting antibiotic is a criterion for referring to hospital as per NICE Pulse May 2019 If urine MCS reports resistance to initial antibiotic, then change treatment as per sensitivities. Use narrow-spectrum antibiotic if possible