American Board of Internal Medicine (ABIM) Certification Practice Exam

What alternative treatment can be used for uncomplicated acute bacterial prostatitis aside from ciprofloxacin?

1. Amoxicillin

2. Trimethoprim-sulfamethoxazole

3. Vancomycin

4. Clindamycin

The correct answer is: Trimethoprim-sulfamethoxazole

Trimethoprim-sulfamethoxazole is an appropriate alternative treatment for uncomplicated acute bacterial prostatitis due to its broad-spectrum activity, particularly against the common pathogens involved, such as Escherichia coli and otherEnterobacteriaceae that are frequently responsible for urinary tract infections, including prostatitis. This combination antibiotic effectively penetrates prostatic tissue and is often recommended as an alternative to fluoroquinolones like ciprofloxacin, especially in cases where patients may have concerns about side effects or resistance issues associated with fluoroquinolones. In contrast, although amoxicillin can treat certain bacterial infections, it lacks efficacy against the more commonly implicated uropathogens in prostatitis, which some strains may be resistant to. Vancomycin primarily targets Gram-positive bacteria and is typically employed for severe infections or those caused by resistant organisms; its use in uncomplicated bacterial prostatitis is not standard. Clindamycin is more targeted toward anaerobic infections and certain Gram-positive pathogens but is less effective against the common uropathogens associated with prostatitis. Thus, the broad coverage and effectiveness of trimethoprim-sulfamethoxazole make it a sensible choice as an alternative treatment.