Dawaa Reference

infectious

Acute bacterial prostatitis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

EAU Guidelines on Urological Infections 2023 · Egyptian National Drug Formulary - Antimicrobial 2023 (ofloxacin monograph, Indications naming Prostatitis and Dosage Regimen, Dosing: Adult usual adult dose), with the 2-to-4-week course from Acute Bacterial Prostatitis - disease-level clinical article (prostatitis-full.txt) · Acute Bacterial Prostatitis - disease-level clinical article (prostatitis-full.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 (norfloxacin monograph, Dosage Regimen, Tablets: Adult dosing, Prostatitis)

Verified against4 documents
  • Acute Bacterial Prostatitis - disease-level clinical article (prostatitis-clinical.txt)
  • Egyptian National Drug Formulary - Antimicrobial 2023 (ofloxacin monograph, Indications naming Prostatitis and Dosage Regimen, Dosing: Adult usual adult dose), with the 2-to-4-week course from Acute Bacterial Prostatitis - disease-level clinical article (prostatitis-full.txt)
  • Acute Bacterial Prostatitis - disease-level clinical article (prostatitis-full.txt)
  • Egyptian National Drug Formulary - Antimicrobial 2023 (norfloxacin monograph, Dosage Regimen, Tablets: Adult dosing, Prostatitis)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (3)

  • Acute bacterial prostatitis presents abruptly with fever, malaise, muscle aches, painful and frequent urination, hesitancy, and pelvic pain, while the chronic form is more subtle [abdominal pain · fever · malaise · muscle pain · pelvic pain · poor urinary stream · urinary frequency]
  • Chronic prostatitis is by definition long-standing and recurring, usually milder than the acute form but still capable of significantly hurting quality of life
  • Men with chronic bacterial prostatitis may also report sexual dysfunction

Signs — what you find (4)

  • In the acute form the prostate is enlarged and exquisitely tender on exam, and vigorous manipulation should be avoided because it can worsen the condition
  • Suprapubic tenderness and fullness suggest urinary retention as a complication [abdominal pain · lower abdominal pain · urinary retention]
  • CVA tenderness should be checked since pyelonephritis is an important differential to exclude [abdominal pain · loin pain]
  • In chronic bacterial prostatitis the gland is not acutely inflamed on exam and the patient does not appear acutely ill, though some men simply carry asymptomatic bacteriuria

Tests (8)

  • Midstream urinalysis and urine culture are the minimum workup once acute bacterial prostatitis is suspected
  • If sepsis criteria are met or the patient carries major comorbidities, obtain blood cultures, lactate, a metabolic panel, and a CBC
  • CT or transrectal ultrasound should be considered for a prostatic abscess in immunocompromised patients or those not improving on treatment
  • PSA, CRP, and ESR add little value in the acute setting because they lack specificity
  • Gonorrhea and chlamydia testing is warranted when an STI is suspected or urethral discharge is present
  • Chronic prostatitis is best confirmed by a specialist using the four-glass Meares-Stamey test or the simpler two-glass pre- and post-massage urine test
  • The four-glass test is rarely used in practice because it is difficult for both patient and provider and rests on weak evidence
  • Biopsy is avoided during active infection because it risks seeding nearby organs and causes severe pain

If not this — what else fits (1)

  • Urethritis, prostate cancer, and urinary tract infection are also on the differential

SourceStatPearls "Acute Bacterial Prostatitis" - disease-level clinical article

Presentation findings are traced to the source above.

Combination safety

Combination regimens

!! MULTI-DRUG REGIMEN - all 2 drugs are given TOGETHER. Not a choice between them.

!! the regimen: Ceftriaxone + Doxycycline

Rx: Main treatment | Oral fluoroquinolone - alternative to ciprofloxacin

MAIN TREATMENT - choose one

1

CIPROFLOXACIN

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg orally twice daily x 14-28 days

Paediatric dose

Adult-only condition - paediatric section not applicable

AWaRe

WATCH group - carries resistance cost. Egyptian EML 2025.

Dose source

Egyptian National Drug Formulary - Antimicrobial 2023

Why

Ciprofloxacin is a fluoroquinolone antibiotic with good penetration into prostatic tissue, making it first-line for acute bacterial prostatitis; the extended course reflects the time needed for adequate clearance of infection from that tissue.

Cautions
  • A minimum 14-day duration is required for adequate prostatic tissue penetration.
  • Refer to urology if urinary retention or prostatic abscess suspected.
  • There is a risk of tendonitis and peripheral neuropathy.
Egyptian brands
Egyptian brandManufacturerIndicative price
QUINOLOROX 500MG 10 F.C. TAB.EPCI > ROXXEN10.00 EGP (1.00/unit)
ECACIPROFLOX 500 MG 20 F.C. TABS.FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > EGYPTIAN CANADIAN PHARMACEUTICAL27.00 EGP (1.35/unit)
ELMODOXACIN 500MG 10 F.C.TAB.EGPI > SEA PHARM20.00 EGP (2.00/unit)
CIPROQUIN 500MG 10 F.C. TAB.UNIPHARMA50.00 EGP (5.00/unit)
CIPROFLOXACIN-ORGANO 500 MG 10 F.C.TABS.ORGANOPHARMA > ORGANO63.00 EGP (6.30/unit)
CIPROFAR 500MG 10 F.C.TAB.PHARCO69.00 EGP (6.90/unit)
CIPROMEGA XL 500MG 10 EXT. REL. F.C.TABS.MASH PREMIERE48.00 EGP
HEROXACIN 500MG 10 SCORED F.C. TAB.EGPI > HERO PHARM69.00 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Paediatric dose

Adult-only condition - paediatric section not applicable

Dose source

Acute Bacterial Prostatitis - disease-level clinical article (prostatitis-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - Sepsis criteria, urinary retention, or risk factors for resistant organisms mean hospital admission and parenteral antibiotics, not the oral outpatient regimen.
3

CEFTRIAXONE

Regimen: prostatitis-sti

1 of 2 - GIVE ALL TOGETHER

Strength1000 mg

Forminjection

Adult dose and duration

1 g by intramuscular injection as a single dose, given together with the doxycycline course, when a sexually transmitted cause is suspected - single IM dose

Paediatric dose

Adult-only condition - paediatric section not applicable

AWaRe

WATCH group - carries resistance cost. Egyptian EML 2025.

Dose source

Acute Bacterial Prostatitis - StatPearls - NCBI Bookshelf (NBK459257) for the indication and the regimen shape - verbatim: "Patients who are suspected of a sexually transmitted cause of prostatitis should be treated with a single dose of intramuscular ceftriaxone followed by two weeks of doxycycline." That sentence gives no milligrams; the dose is from Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph) - verbatim: "IV or IM 1-2 g once or devided twice daily", 1 g vial.

Why

Covers Neisseria gonorrhoeae, which the fluoroquinolones on this list no longer reliably treat. Paired with doxycycline for chlamydia.

Cautions
  • Suspect a sexually transmitted cause in a younger man, with urethral discharge, or with a recent new partner - test for gonorrhoea and chlamydia before or alongside treatment.
  • Treat the partner too, or the patient is reinfected.
  • Do not give to a patient with a history of anaphylaxis to penicillin - the cross-reactivity is low but not zero, and this is an injection given in the clinic.
Egyptian brands
Egyptian brandManufacturerIndicative price
ZOXIDEL 1 GM PD. FOR I.M. INJ.RAMEDA > DELTA PHARMA22.00 EGP
CEFTRIAXONE SODIUM 1 GM I.M.VIAL (KAHIRA)KAHIRA29.00 EGP
ZOXIDEL 1 GM PD. FOR I.V. INJ.RAMEDA > DELTA PHARMA29.00 EGP
WINTRIAXONE 1 GM PD. FOR I.V INJ.SANOFI48.00 EGP
VOTRIAXONE 1 GM I.M VIALCHEMIPHARM56.00 EGP
OFRAMAX 1 GM I.M. VIALRAMEDA > SUN PHARMA EGYPT LIMITED71.00 EGP
TRIAXONE 1 GM I.M. VIALTABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA106.00 EGP
TRIAXONE 1 GM I.V VIALTABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA106.00 EGP
4

DOXYCYCLINE

Regimen: prostatitis-sti

2 of 2 - GIVE ALL TOGETHER

Strength100 mg

Formoral.solid

Adult dose and duration

100 mg orally twice daily, started with the ceftriaxone dose, when a sexually transmitted cause is suspected x 14 days

Paediatric dose

Adult-only condition - paediatric section not applicable

Dose source

Acute Bacterial Prostatitis - StatPearls - NCBI Bookshelf (NBK459257) for the indication and the two-week course - verbatim: "Patients who are suspected of a sexually transmitted cause of prostatitis should be treated with a single dose of intramuscular ceftriaxone followed by two weeks of doxycycline." Milligrams from Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph) - verbatim: "Usual dosage range: Oral: IR and most ER formulations: 100 to 200 mg/day in 1 to 2 divided doses", 100 mg capsules.

Why

Covers Chlamydia trachomatis and the other atypical organisms, and reaches the prostate. The full two weeks matters - a shorter course relapses.

Cautions
  • Take with a full glass of water, sitting upright, and not at bedtime - it causes oesophageal ulceration otherwise.
  • Causes photosensitivity. Relevant in Cairo: advise sun protection over the fortnight.
  • Separate from antacids, iron, and dairy by two hours, which otherwise bind it and stop it being absorbed.
Egyptian brands
Egyptian brandManufacturerIndicative price
FARCODOXIN 100MG 10 CAPS.PHARCO11.00 EGP (1.10/unit)
DOXY M.R.100 MG 10 CAPS.ADWIA12.00 EGP (1.20/unit)
GRANUDOXY 100MG 10 F.C. TAB.GLOBAL NAPI PHARMACEUTICALS > PIERRE FRANCE12.00 EGP (1.20/unit)
DOXYDOX 100 MG 10 CAPS.EIPICO23.00 EGP (2.30/unit)
DOXYMYCIN 100 MG 10 CAPS.EL NILE.30.00 EGP (3.00/unit)
TABOCINE 100MG 10 CAPS.TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA46.00 EGP (4.60/unit)
VIBRAMYCIN 100MG 10 CAPS.PFIZER65.00 EGP (6.50/unit)

ORAL FLUOROQUINOLONE - ALTERNATIVE TO CIPROFLOXACIN - choose one

5

OFLOXACIN

Oral fluoroquinolone - alternative to ciprofloxacin

2nd line

Strength200 mg

Formoral.solid

Adult dose and duration

200 to 400 mg every 12 hours x 2 to 4 weeks

Paediatric dose

Adult-only condition - paediatric section not applicable

Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (ofloxacin monograph, Indications naming Prostatitis and Dosage Regimen, Dosing: Adult usual adult dose), with the 2-to-4-week course from Acute Bacterial Prostatitis - disease-level clinical article (prostatitis-full.txt)

Why

One document carries both claims. The Egyptian formulary's ofloxacin monograph names prostatitis in its own indication list and states a dose: for an adult, 200 to 400 mg, one dose every 12 hours. Ofloxacin is the alternative for a patient in whom ciprofloxacin is unsuitable. The course length is the disease article's, which puts oral fluoroquinolones at 2 to 4 weeks; the formulary attaches no duration to its prostatitis indication and the citation names both documents.

Cautions
  • CONTRAINDICATED where the patient is hypersensitive to ofloxacin, to any other quinolone, or to any of the product's other ingredients.
  • The formulary names prostatitis in ofloxacin's indications but states no prostatitis-specific regimen or duration. The 200 to 400 mg every 12 hours is its usual adult dose; the 2-to-4-week course is the disease article's figure for oral fluoroquinolones in acute bacterial prostatitis.
  • Fluoroquinolone class risks apply: tendinitis and tendon rupture, peripheral neuropathy, CNS effects, QT prolongation and disordered glucose regulation.
  • Separate from antacids, calcium, iron, magnesium and lanthanum - they block absorption.
  • Severe hepatic impairment (for example cirrhosis with or without ascites): maximum 400 mg/day.
  • Sepsis, urinary retention, or risk factors for resistant organisms mean admission and parenteral therapy, not an oral course.
Egyptian brands
Egyptian brandManufacturerIndicative price
JEDCOFLACIN 200 MG 20 F.C.TAB.JEDCO INT. CO. FOR PHARMACEUTICALS43.25 EGP (2.16/unit)
OFLOXIN 200MG 10 F.C.TAB.KAHIRA21.60 EGP (2.16/unit)
OFLICIN 200MG 10 F.C.TAB.MEMPHIS24.00 EGP (2.40/unit)
EPICOFLOCIN 200 MG 10 F.C.TABS.EIPICO28.00 EGP (2.80/unit)
OFLOXACIN 200MG 10 TABSEDICO30.00 EGP (3.00/unit)
KIROLL 200MG 10 F.C. TAB.GLAXO SMITHKLINE34.50 EGP (3.45/unit)
TARIVAN 200MG 10 TAB.ALEXANDRIA44.00 EGP (4.40/unit)
TARIVID 200MG 10 F.C. TAB.SANOFI82.00 EGP (8.20/unit)
6

NORFLOXACIN

Oral fluoroquinolone - alternative to ciprofloxacin

2nd line

Strength400 mg

Formoral.solid

Adult dose and duration

400 mg every 12 hours x 4 to 6 weeks

Paediatric dose

Adult-only condition - paediatric section not applicable

Choice

Sourced preference over the ofloxacin row beside it. The formulary prints a prostatitis regimen for norfloxacin by name - by mouth, 400 mg every 12 hours, the course running 4 to 6 weeks - so drug, dose and duration all come from one document. Ofloxacin's row carries the formulary's general adult dose and takes its 2-to-4-week course from the disease article instead. Ciprofloxacin remains the card's main treatment; this pair is what to use when ciprofloxacin is unsuitable.

Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (norfloxacin monograph, Dosage Regimen, Tablets: Adult dosing, Prostatitis)

Why

One document carries drug, dose AND duration. The Egyptian formulary's norfloxacin monograph prints an explicit prostatitis regimen in its own dosing table - by mouth, 400 mg every 12 hours, and the course runs 4 to 6 weeks - which is better sourced than the ofloxacin row beside it, whose 2-to-4-week course had to be taken from the disease article. The condition's article supplies the class-level indication: a patient who is not severely ill can go home on an oral fluoroquinolone or on Bactrim for 2 to 4 weeks, with a follow-up culture to confirm it has cleared. Seven Egyptian norfloxacin products are registered, six of them 400 mg tablets.

Cautions
  • CONTRAINDICATED where the patient is hypersensitive to norfloxacin, to quinolones as a class, or to any of the product's other ingredients - and, for the tablets, where there is a past tendinitis or tendon rupture linked to a quinolone.
  • The formulary's own Indications line for the tablets is narrower than its dosing table - it lists urinary tract infection, complicated or not, from susceptible gram-negative and gram-positive organisms. Prostatitis is named in the Dosage Regimen, not in that list, and the disease article is what recommends an oral fluoroquinolone for this condition.
  • The formulary's course is 4 to 6 weeks and the article's is 2 to 4 weeks for oral fluoroquinolones generally; the row prints the formulary's, because that is the figure attached to prostatitis by name.
  • Take with water on an empty stomach - 1 hour or more before food, or 2 hours after it; the same spacing applies to milk and other dairy. The instruction is the formulary's.
  • Antacids, sucralfate and any multivitamin or supplement carrying iron, zinc, magnesium or aluminium must never be given at the same time as norfloxacin - separate them by 2 hours at least, either side of the dose.
  • Renal impairment: at a CrCl of 30 mL/minute/1.73 m2 or below, the formulary gives 400 mg once daily.
  • It is not to be used where there is a known aortic aneurysm, nor where the risk of one is raised - peripheral atherosclerotic vascular disease, hypertension, or an inherited disorder that alters the blood vessels. The warning is the formulary's.
  • Fluoroquinolone class risks apply: tendinitis and tendon rupture, peripheral neuropathy, CNS effects, QT prolongation and disordered glucose regulation.
  • Sepsis, urinary retention, or risk factors for resistant organisms mean admission and parenteral therapy, not an oral course.
Egyptian brands
Egyptian brandManufacturerIndicative price
NORBACTIN 400MG 10 F.C.TAB.T3A PHARMA > RANBAXY17.40 EGP (1.74/unit)
NORMASH 400MG 10 F.C. TAB.MASH PREMIERE18.00 EGP (1.80/unit)
NORACIN 400MG 10 F.C.TAB.MEMPHIS22.68 EGP (2.27/unit)
EPINOR 400MG 14 TAB.EIPICO35.00 EGP (2.50/unit)
NEOFLOXIN 400MG 16 F.C. TAB.ALEXANDRIA43.00 EGP (2.69/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.