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Acute bacterial prostatitis — MSRA MCQ

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HardUrinary Tract InfectionsAcute bacterial prostatitisMSRA

A 58-year-old man presents with 3 days of dysuria, urinary frequency, fever and deep perineal pain. He has no urethral discharge, loin pain, vomiting or recent urological instrumentation. His temperature is 38.2°C, heart rate 94 beats/minute and blood pressure 128/76 mmHg. He is able to drink and take oral medication. Abdominal examination is benign; bladder is not palpable. Digital rectal examination shows a diffusely tender, boggy prostate. He has no acute urinary retention, confusion or other features of sepsis. eGFR is 52 mL/minute/1.73 m². A urine culture 5 months ago grew Escherichia coli resistant to trimethoprim but susceptible to ciprofloxacin and nitrofurantoin. He has had no quinolone-related adverse effects and no antibiotic treatment in the past 3 months. What is the most appropriate management now?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Send a midstream urine sample and prescribe ciprofloxacin 500 mg twice daily for 14 days, with review at 14 days

Explanation lettering: E = shown as A · C = shown as B · D = shown as C · B = shown as D · A = shown as E

This presentation is acute bacterial prostatitis: systemic features with deep perineal pain and a diffusely tender, boggy prostate distinguish it from uncomplicated lower UTI. He is haemodynamically stable, can take oral treatment and has neither retention nor sepsis, so immediate hospital admission and intravenous therapy are not indicated. A midstream urine specimen should be obtained before antibiotics. Ciprofloxacin 500 mg twice daily for 14 days followed by clinical review is the NICE first-choice oral regimen, guided by susceptibility where available. His previous isolate was ciprofloxacin-susceptible, and his renal function permits this dose. Fluoroquinolone adverse effects and safety precautions should be discussed. A is plausible because nitrofurantoin is suitable for lower UTI and his eGFR is adequate, but it does not achieve therapeutic prostatic concentrations. B is inappropriate both because the prior isolate was trimethoprim-resistant and because 7 days is insufficient for acute prostatitis. C would be appropriate if he were severely unwell, unable to take oral medication, septic or in acute retention, none of which applies. D risks delaying treatment for a potentially serious bacterial infection; culture should guide subsequent review rather than postpone empiric treatment.

Reference: NICE NG110: Prostatitis (acute): antimicrobial prescribing — Recommendations (2018; checked 15 August 2026) — https://www.nice.org.uk/guidance/ng110/chapter/Recommendations NICE NG110: Prostatitis (acute): antimicrobial prescribing — Table 1 (2018; checked 15 August 2026) — https://www.nice.org.uk/guidance/ng110/chapter/Recommendations NICE NG109: Urinary tract infection (lower): antimicrobial prescribing — Men with lower UTI (2018; checked 15 August 2026) — https://www.nice.org.uk/guidance/ng109/chapter/Recommendations