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Acute bacterial prostatitis — MSRA MCQ

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ModerateUrologyAcute bacterial prostatitisMSRA

A 59-year-old man presents with 24 hours of fever, dysuria, urinary frequency and deep perineal pain. He is haemodynamically stable, can take oral medication and has no vomiting, urinary retention or features of sepsis. Examination shows a tender, boggy prostate. A midstream urine specimen has been obtained before antibiotics. His eGFR is 78 mL/min/1.73 m². Three years ago, ciprofloxacin for pyelonephritis was stopped after he developed Achilles tendinopathy requiring physiotherapy. A previous urine culture grew Escherichia coli susceptible to trimethoprim. What is the most appropriate immediate antimicrobial management?

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

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Correct answer: C — Seek specialist advice and start oral trimethoprim 200 mg twice daily for 14 days, then review

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

This presentation is acute bacterial prostatitis: fever, lower urinary tract symptoms, perineal pain and a tender boggy prostate support prostatic rather than uncomplicated lower urinary tract infection. He is clinically stable, has no retention or sepsis, and can take oral medication, so oral therapy is appropriate after obtaining a urine culture. Trimethoprim 200 mg twice daily for 14 days then review is the NICE alternative first-choice oral antibiotic when a fluoroquinolone is inappropriate; NICE advises seeking specialist advice. His previous ciprofloxacin-associated Achilles tendinopathy is a serious fluoroquinolone adverse reaction, so ciprofloxacin should be avoided despite being a standard first-choice option in uncomplicated circumstances. At 14 days, treatment should be reassessed and stopped or extended for a further 14 days according to clinical response and investigation results. A is unsafe because of the prior serious fluoroquinolone reaction. C is a plausible lower-UTI regimen, but nitrofurantoin does not provide appropriate treatment for suspected prostatic infection. D is a second-choice option after specialist discussion and should be reserved for situations with bacteriological sensitivity and a reason to prefer it to a single agent. E would be appropriate if he were severely unwell, unable to take oral treatment, septic, or had a complication such as acute urinary retention.

Reference: NICE NG110: Prostatitis (acute): antimicrobial prescribing — Recommendations (Published 31 October 2018; updated September 2024) — https://www.nice.org.uk/guidance/ng110/chapter/Recommendations MHRA Drug Safety Update: Fluoroquinolone antibiotics must now only be prescribed when other commonly recommended antibiotics are inappropriate (January 2024) — https://www.gov.uk/drug-safety-update/fluoroquinolone-antibiotics-must-now-only-be-prescribed-when-other-commonly-recommended-antibiotics-are-inappropriate?es_c=4D8E57EB7462CC94BCC96A821 Ciprofloxacin 250 mg film-coated tablets — Summary of Product Characteristics (Last updated 9 June 2026) — https://www.medicines.org.uk/emc/product/7256/smpc