What is the best initial treatment for chronic bacterial prostatitis?

Chronic bacterial prostatitis, a persistent infection of the prostate gland, is primarily caused by specific bacteria that can be challenging to treat due to the anatomy and physiology of the prostate. The most effective initial treatment for this condition involves the use of fluoroquinolone antibiotics, primarily because they have excellent tissue penetration and are effective against the organisms typically responsible for this infection.

Levofloxacin, being a fluoroquinolone, is particularly advantageous for treating chronic bacterial prostatitis due to its potency against both gram-positive and gram-negative bacteria, including those that are commonly implicated in urinary tract infections and prostatitis. Its ability to achieve high concentrations in prostatic tissue makes it a suitable choice for addressing both the bacterial infection and inflammation associated with prostatitis.

In contrast, other antibiotics listed, such as penicillin, cephalexin, and nitrofurantoin, may not provide adequate coverage for the bacteria commonly seen in chronic bacterial prostatitis or may not penetrate sufficiently into the prostate tissue to achieve therapeutic levels. Therefore, levofloxacin is favored as the best initial treatment because of its efficacy and pharmacokinetics in treating this particular condition.