Type of therapy		Dosage/treatment plan	Comments
Pharmacologic
First-line
Antimicrobials		Ciprofloxacin (Cipro), 500 mg orally twice daily for four to six weeks Trimethoprim/sulfamethoxazole (Bactrim, Septra), 160 mg/800 mg orally twice daily for four to six weeks38	No difference between ciprofloxacin and no ciprofloxacin (P = .15)38,39
Second-line
Alpha blockers		Tamsulosin (Flomax), 0.4 mg daily Alfuzosin (Uroxatral), 10 mg daily for 12 weeks	No difference compared with placebo39 Decline of National Institutes of Health Chronic Prostatitis Symptom Index score ≥ 4 showed no difference compared with placebo40
Third-line
Anti-inflammatory agents		Pentosan (Elmiron), 900 mg daily for 16 weeks Finasteride (Proscar), 5 mg daily for six months Quercetin (a bioflavonoid supplement), 500 mg twice daily for 30 days	Clinical global improvement: 36.7 vs.17.8 percent with placebo41 Global assessment improvement: 44 vs. 27 percent with placebo42 67 percent quercetin vs. 20 percent placebo showed > 25 percent improvement in symptoms43
Other
Anticonvulsants		Pregabalin (Lyrica) Gabapentin (Neurontin)	No specific data44
Tricyclic antidepressants		Nortriptyline (Pamelor), 10 mg daily at bedtime with titration up to 75 to 100 mg	No specific data45
Nonpharmacologic
Biofeedback		—	Small study, statistically significant improvement in American Urological Association symptom score, decrease in bother score, decrease in pain score46
Cognitive behavior therapy		—	No published data47
Physical therapy		—	Small pilot study, no difference in improvement between global massage therapy vs. myofascial physical therapy 48
Sacral neuromodulation		—	Two uncontrolled studies have shown some effectiveness49,50
Thermal therapy		Microwave and transurethral needle ablation	Little improvement, consider as last resort51