What is the antibiotic of choice for acute prostatitis?

Ciprofloxacin is the antibiotic of choice for acute prostatitis, particularly when the condition is caused by bacterial infections. Acute prostatitis is often associated with uropathogenic organisms, and fluoroquinolones like ciprofloxacin have excellent tissue penetration, including into prostatic tissue. This makes them effective in targeting the pathogens that typically cause this condition, such as Escherichia coli and other Enterobacteriaceae.

In addition to its effectiveness, ciprofloxacin is considered for its broad-spectrum antimicrobial activity, which is critical when the specific bacteria causing the infection has not yet been identified. Treatment usually spans several weeks due to the difficulty of eradicating infections from prostate tissue.

Other antibiotics mentioned, such as metronidazole (Flagyl), are typically not first-line treatments for acute prostatitis, especially since they target anaerobic bacteria and protozoa rather than the aerobic organisms commonly involved in prostatitis. Similarly, cephalexin (Keflex) primarily covers Gram-positive bacteria and is less effective for the Gram-negative bacteria that frequently cause this infection. Azithromycin is primarily used for respiratory and atypical infections and does not have adequate coverage for the organisms responsible for acute prostatitis. Therefore, ciprofloxacin remains the preferred