American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the empirical treatment for uncomplicated acute bacterial prostatitis?

1. Trimethoprim-sulfamethoxazole for 4 weeks

2. Ciprofloxacin for 4 to 6 weeks

3. Amoxicillin for 2 weeks

4. Doxycycline for 1 month

The correct answer is: Ciprofloxacin for 4 to 6 weeks

The empirical treatment for uncomplicated acute bacterial prostatitis is typically guided by the likely pathogens involved, which primarily include Escherichia coli and other gram-negative bacteria. Ciprofloxacin is a fluoroquinolone antibiotic that is effective against these organisms and is often chosen for its ability to penetrate prostate tissue effectively. The recommended duration of therapy for acute bacterial prostatitis usually ranges from 4 to 6 weeks, reflecting the need to ensure adequate treatment of the infection and to prevent complications such as abscess formation. This extended duration of therapy is particularly important in prostatitis cases due to the anatomy and potential difficulties in effectively eliminating the infection from the prostate gland. Other options may be less suitable: while trimethoprim-sulfamethoxazole can be effective, it is not typically the first-line choice. Amoxicillin lacks the necessary coverage for the common pathogens involved in prostatitis. Doxycycline, while useful for certain infections, is not the preferred choice for acute bacterial prostatitis due to its limited effectiveness against the usual bacterial culprits. Thus, ciprofloxacin is favored for its efficacy and penetration, making it the correct empirical treatment in this scenario.