What is the most appropriate treatment choice for chronic bacterial prostatitis in a 52-year-old man?

The most appropriate treatment for chronic bacterial prostatitis is oral ciprofloxacin for 28 days. This choice is based on the understanding that chronic bacterial prostatitis is often caused by specific strains of bacteria, particularly those within the family of Enterobacteriaceae. Fluoroquinolones such as ciprofloxacin have excellent tissue penetration, particularly in the prostatic tissue, and they are effective against many of the bacteria that cause chronic prostatitis.

The recommended duration of treatment—28 days—is important because chronic prostatitis is typically a more persistent infection that requires a longer course of antibiotics to achieve adequate bacterial eradication and symptom resolution. Shorter courses may not be sufficient to fully eradicate the infection and may lead to recurrence.

In contrast, other options might not be as effective due to issues such as inadequate duration of treatment or insufficient coverage against the pathogens involved in chronic bacterial prostatitis. For instance, TMP-SMX, while effective for some urinary tract infections, is often not the first choice for prostatitis due to issues with penetration and resistance patterns. Similarly, although ceftriaxone and doxycycline may be useful for different infections, they do not have the same level of efficacy and suitability for treating chronic bacterial prostatitis as ciprofloxacin does.