What is the standard initial antibiotic therapy for acute bacterial prostatitis in otherwise healthy men?

• A. Fluoroquinolone (e.g., ciprofloxacin) or TMP-SMX for 4–6 weeks.
• B. Cephalosporin for 1 day
• C. Macrolide for 2 days
• D. Penicillin V for 1 week

Answer: (A)

The key idea is using an antibiotic that both treats the usual bacteria causing acute bacterial prostatitis and penetrates well into prostate tissue. Fluoroquinolones (like ciprofloxacin) and trimethoprim-sulfamethoxazole have excellent penetration into the prostate and robust activity against common causative organisms such as E. coli and other enteric Gram-negatives. Because the infection is in a relatively protected organ, treatment needs to be relatively prolonged to ensure eradication and prevent relapse, so a 4–6 week course is standard rather than a short 1–2 day or 1-week duration.

Other options fail for two main reasons: they either do not achieve reliable prostatic tissue levels or are not broad enough against the typical pathogens, and they are prescribed for too short a period to clear an intraprostatic infection. In healthy men with acute bacterial prostatitis, starting with a fluoroquinolone or TMP-SMX for several weeks provides the best balance of tissue penetration, organism coverage, and treatment duration.