Dr. Douglas Brum
The treatment for prostatitis varies depending on whether the disease is acute or chronic. Acute prostatitis is a much more critical condition than chronic prostatitis and requires more immediate and aggressive care. When evaluating a dog for chronic prostatitis, it is generally appropriate to wait until a definitive diagnosis has been established prior to beginning therapy. In this way, appropriate antibiotic therapy may be started based on culture and sensitivity results. This may not be an option in some of the acute cases since the animal may require emergency treatment before the diagnostic test results are back. Antibiotics. Antibiotics are the hallmark of treating prostatitis. The choice of specific antibiotics depends on the results of the cultures taken, and the ability of the antibiotic to penetrate the prostatic tissue. Not all antibiotics have an equal ability to enter the prostate (cross the blood-prostatic fluid barrier). Antibiotics that are effective include: erythromycin, clindamycin, chloramphenicol, trimethoprim/sulfonamide and the quinolones.
The decision as to when to begin therapy depends on the clinical assessment of the patient. In general, a more rapid treatment is required for the acute disease, and a longer treatment course is needed for the chronic condition. Although animals are sicker with the acute disease, it is generally easier to achieve a complete cure than with the chronic disease. Dogs with chronic prostatitis are more likely to have a continued intermittent problem despite therapy. Chronic prostatitis is a difficult disease to cure. Specific treatment includes:
In the acute condition, this choice is not as critical since the blood-prostatic barrier is not intact, and different antibiotics will penetrate the prostate effectively. Acute prostatitis is often treated with intravenous antibiotics initially, depending on the clinical condition of the animal. These antibiotics are usually started prior to receiving the results of the cultures. The antibiotics may be changed to an oral form once the pet is stable and culture results are back. Acute prostatitis is usually treated for a minimum of 4 weeks. In chronic prostatitis it is very important to base the choice of antibiotics on the culture results while choosing an antibiotic with good penetration into the prostate.
Chronic prostatitis is more often treated for at least six weeks. In some cases, chronic prostatitis may not be curable. These animals may require life long antibiotic therapy. Antibiotics that are continued for life usually can be used at a lower dose.
Intravenous fluids. Intravenous fluids are sometimes needed in animals with acute prostatitis that are either dehydrated, in shock, or septic (bacterial blood infection). Fluid therapy maintains tissue perfusion, blood pressure and circulatory status in the critical patient.
Acute prostatitis can be quite painful. Providing pain relief while a diagnosis is pending will allow the dog to be more comfortable and to be able to rest. Narcotics and nonsteroidal anti-inflammatory drugs are most commonly used. Usually, pain medications are only needed during the initial in-hospital treatment of the patient. Animals with chronic prostatitis usually do not require analgesic medication.
Neutering. Animals with chronic prostatitis may benefit from castration. Castration decreases the hormone levels that stimulate the prostate, thereby causing the amount of prostatic tissue to shrink. Some dogs with chronic recurrent disease seem to have improvement of signs with neutering. Additionally, a certain number of dogs with acute disease may also go on to develop the chronic condition. Neutering may help the development of the more chronic disease.
Optimal treatment for your pet requires a combination of home and professional veterinary care. Follow-up can be critical, especially if your pet does not improve rapidly.
Administer all medications as directed. Alert your veterinarian if you are experiencing problems treating your pet.
Animals with both acute and chronic prostatitis are prone to having repeated episodes of infection. Recheck physical examinations, prostatic palpation and good communication are important parts of continued care.
After finishing antibiotics, it is very important to have cultures repeated to assure that the infection has cleared. Urine and or prostatic fluid may be cultured. In cases of chronic prostatitis, an additional culture should be considered one month later.
If relapses are noted either by clinical signs or by a positive culture, antibiotic therapy will need to be continued on a more long- term basis. Antibiotics may need to be continued for months or potentially as life-long therapy.
In all cases of prostatitis, antibiotics are used for a fairly long duration. Depending on the antibiotic your pet is on, you should be aware of any potential side effects of long term administration. All antibiotics can cause gastrointestinal signs like diarrhea, but some may have more individual effects. Potential side effects should be discussed with your veterinarian.