Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a guideline (underpinned by a systematic review) that focuses on the above important clinical question.
Confidence in the evidence is very low or low where GRADE has been performed and there may be no difference in effectiveness between the intervention and comparison for key outcomes. However, this is uncertain and new evidence could change this in the future.
Population: Men with, or at risk of, acute prostatitis ᵃ
Intervention: Intravenous antimicrobial pharmacological interventions (alone or in combination with an oral antibiotic) ᵇ
Comparison: Each other
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Oral ciprofloxacin and oral metronidazole plus intravenous ceftazidime versus oral ciprofloxacin and oral metronidazole plus intravenous ceftazidime and intravenous amikacin | ||
Incidence of acute prostatitis post biopsy | No statistically significant difference | Very Low |
An oral fluoroquinolone plus intravenous ceftriaxone versus an oral fluoroquinolone alone | ||
Infectious complications post biopsy including acute prostatitis: ceftriaxone and a fluoroquinolone (3 days) versus a fluoroquinolone (3 days) | Favours a fluoroquinolone plus ceftriaxone (3 days) | Very Low |
Infectious complications post biopsy including acute prostatitis: ceftriaxone and a fluoroquinolone (7 days) versus a fluoroquinolone (3 days) | Favours a fluoroquinolone plus ceftriaxone (7 days) | Very Low |
Recommendations as stated in the source guideline Offer an antibiotic to people with acute prostatitis. Take account of: The severity of symptoms The risk of developing complications or having treatment failure, particularly after medical procedures such as prostate biopsy Previous urine culture and susceptibility results Previous antibiotic use, which may have led to resistant bacteria. Choice of antibiotic: When prescribing an antibiotic for acute prostatitis, take account of local antimicrobial resistance data and follow table 1 for adults aged 18 years and over. Give oral antibiotics first line if the person can take oral medicines, and if the severity of their condition does not require intravenous antibiotics. Review intravenous antibiotics by 48 hours and consider stepping down to oral antibiotics where possible. Review antibiotic treatment after 14 days and either stop the antibiotic or continue for a further 14 days if needed, based on an assessment of the person's history, symptoms, clinical examination, urine, and blood tests.
Note The guideline committee made a research recommendation asking the question “Which antibiotics (at what dose and for what duration) are effective and safe in treating acute prostatitis, and preventing complications?”. This is because the evidence identified was indirect and very limited, meaning it was not possible to recommend any particular antimicrobial regimen, especially for parenteral antibiotics where ciprofloxacin, levofloxacin, cefuroxime, ceftriaxone, gentamicin, and amikacin were all listed by the guideline as first-line options if an intravenous antibiotic is prescribed. This is reflected in the overall evidence rating for this table, which states there is no difference in effectiveness between interventions. None of the included studies had data on safety or tolerability. ᵃ NICE did not identify any evidence for treating men with a diagnosis of acute prostatitis. They therefore included indirect evidence from studies looking at preventing acute prostatitis in men undergoing prostate biopsy. ᵇ Antimicrobial pharmacological interventions include oral and parenteral, narrow or broad spectrum, dual or triple therapy, and escalation or de-escalation of treatment. NICE also looked for evidence comparing antimicrobial pharmacological interventions with placebo/no treatment, non-pharmacological interventions, and non-antimicrobial pharmacological interventions. However, they did not find any relevant studies.
This evidence table is related to the following section/s:
This table is a summary of the analysis reported in a guideline (underpinned by a systematic review) that focuses on the above important clinical question.
Confidence in the evidence is very low or low where GRADE has been performed and the intervention may be more effective/beneficial than the comparison for key outcomes. However, this is uncertain and new evidence could change this in the future.
Population: Men with, or at risk of, acute prostatitis ᵃ
Intervention: Oral antimicrobial pharmacological interventions (alone or in combination with an intravenous antibiotic) ᵇ
Comparison: Each other
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Oral ciprofloxacin and oral metronidazole plus intravenous ceftazidime versus oral ciprofloxacin and oral metronidazole plus intravenous ceftazidime and intravenous amikacin | ||
Incidence of acute prostatitis post biopsy | No statistically significant difference | Very Low |
An oral fluoroquinolone plus intravenous ceftriaxone versus an oral fluoroquinolone alone | ||
Infectious complications post biopsy including acute prostatitis: ceftriaxone and a fluoroquinolone (3 days) versus a fluoroquinolone (3 days) | Favours a fluoroquinolone plus ceftriaxone (3 days) | Very Low |
Infectious complications post biopsy including acute prostatitis: ceftriaxone and a fluoroquinolone (7 days) versus a fluoroquinolone (3 days) | Favours a fluoroquinolone plus ceftriaxone (7 days) | Very Low |
Recommendations as stated in the source guideline Offer an antibiotic to people with acute prostatitis. Take account of: The severity of symptoms The risk of developing complications or having treatment failure, particularly after medical procedures such as prostate biopsy Previous urine culture and susceptibility results Previous antibiotic use, which may have led to resistant bacteria Choice of antibiotic: When prescribing an antibiotic for acute prostatitis, take account of local antimicrobial resistance data and follow table 1 for adults aged 18 years and over. Give oral antibiotics first line if the person can take oral medicines, and if the severity of their condition does not require intravenous antibiotics. Review intravenous antibiotics by 48 hours and consider stepping down to oral antibiotics where possible. Review antibiotic treatment after 14 days and either stop the antibiotic or continue for a further 14 days if needed, based on an assessment of the person's history, symptoms, clinical examination, urine, and blood tests.
Note Although the evidence identified was indirect and very limited, the guideline committee recommended an oral fluoroquinolone (ciprofloxacin or ofloxacin) as the first-choice oral antibiotic. This is reflected in the overall evidence rating for this table, which is an acknowledgement of oral fluoroquinolones as first-choice antibiotic. None of the included studies had data on safety or tolerability. ᵃ NICE did not identify any evidence for treating men with a diagnosis of acute prostatitis. They therefore included indirect evidence from studies looking at preventing acute prostatitis in men undergoing prostate biopsy. ᵇ Antimicrobial pharmacological interventions include oral and parenteral, narrow- or broad-spectrum, dual or triple therapy, and escalation or de-escalation of treatment.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- What are the benefits and harms of pharmacological interventions for treating men with chronic prostatitis/chronic pelvic pain syndrome?
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