Acute Prostatitis and Epididymitis (Antimicrobial)


Bacterial Prostatitis 

Send initial voided urine sample (first 5 to 10mL) to Virology for Chlamydial DNA strand amplification and MSU to bacteriology.

Consider semen culture.

4 weeks treatment may prevent chronic infection.


Age 35 years and under, likely to be sexually transmitted. Send urine samples to Virology and Microbiology as for bacterial prostatitis. If chlamydia isolated treat partner (see section on genital-tract infections). 

Age over 35 years, common uropathogens responsible. Send MSU to bacteriology and treat according to sensitivities. Suitable agents with good tissue penetration include ciprofloxacin, trimethoprim and cefalexin. If recurrent, refer to Urology Outpatients.

The European Medicines Agency's Pharmacovigilance Risk Assessment Committee has recommended restricting the use of fluoroquinolone antibiotics following a review of disabling and potentially long-lasting side effects mainly involving muscles, tendons, bones and the nervous system (press release October 2018), but they are an option in acute pyelonephritis, which is a severe infection.

A lower risk of resistance may be more likely if not used in the past 3 months, previous urine culture suggests susceptibility (but this was not used), and in younger people in areas where local epidemiology data suggest resistance is low. A higher risk of resistance may be more likely with recent use and in older people in residential facilities.

For glossary of terms see Glossary.

Drug details

Bacterial Prostatitis

Trimethoprim 200mg twice daily OR ciprofloxacin 750mg twice daily (see BNF warnings and MHRA Drug Safety Alert (updated 22 January 2024))

14 days

Epididymitis - age 35 and under

Doxycycline 100mg twice daily

14 days

Epididymitis - age over 35 years

Cefalexin 500mg 3 times daily OR trimethoprim 200mg twice daily OR ciprofloxacin 750mg twice daily (see BNF warnings and MHRA Drug Safety Alert (updated 22 January 2024))

14 days

Editorial Information

Last reviewed: 25/08/2022

Next review date: 25/08/2025

Author(s): Antimicrobial Management Team.

Version: 2.1

Approved By: TAM subgroup of ADTC

Reviewer name(s): Alison Macdonald, Area Antimicrobial Pharmacist.

Document Id: AMT181