Comparative analysis of azithromycin and ciprofloxacin in the treatment of chronic prostatitis caused by Chlamydia trachomatis

Škerk, Vedrana

doi:10.1016/s0924-8579(03)00056-6

Cited by 36 publications

(18 citation statements)

References 23 publications

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“…Azithromycin was administered only during the first 3 consecutive days at the beginning of each week of treatment with the fluoroquinolone (''pulse therapy''), as previously described. 18,28,29 In agreement with the algorithm recommended by Wagenlehner and Naber, 30 patients remained on continuous treatment with the alphaadrenoceptor blocker alfuzosin ER (10 mg day 21 ) for a period of 6 months, during which time a supplement containing Serenoa repens extract (640 mg day 21 ), lycopene (5 mg day 21 ) and selenium (50 mg day 21 ) in a single formulation was also administered. 31 Four weeks after the end of antimicrobial treatment, the patients were subjected to a complete diagnostic protocol, including microbiological and clinical evaluations.…”

Section: Diagnostic Proceduresmentioning

confidence: 91%

Fluoroquinolone–macrolide combination therapy for chronic bacterial prostatitis: retrospective analysis of pathogen eradication rates, inflammatory findings and sexual dysfunction

Magri¹,

Montanari²,

Škerk³

et al. 2011

Asian J Androl

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We previously demonstrated the safety and efficacy of fluoroquinolone-macrolide combination therapy in category II chronic bacterial prostatitis (CBP). The aim of this study is to retrospectively compare the microbiological and clinical findings of two treatment schemes for CBP based on the combination of azithromycin (500 mg, thrice-weekly) with a once-daily 500-or 750-mg dose of ciprofloxacin (Cipro-500 or Cipro-750 cohort, respectively). Combined administration of azithromycin (1500 mg week 21 ) with ciprofloxacin at the rate of 750 mg day 21 for 4 weeks rather than at 500 mg day 21 for 6 weeks increased the eradication rates from 62.35% to 77.32% and the total bacteriological success from 71.76% to 85.57%. A significant decrease in pain and voiding signs/symptoms and a significant reduction in inflammatory leukocyte counts and serum prostate-specific antigen (PSA) were sustained throughout an 18-month follow-up period in both groups. Ejaculatory pain, haemospermia and premature ejaculation were significantly attenuated on microbiological eradication in both groups, but the latter subsided more promptly in the Cipro-750 cohort. In total, 59 Cipro-750 patients showed mild-to-severe erectile dysfunction (ED) at baseline, while 22 patients had no ED on microbiological eradication and throughout the follow-up period. In conclusion fluoroquinolone-macrolide therapy resulted in pathogen eradication and CBP symptom attenuation, including pain, voiding disturbances and sexual dysfunction. A once-daily 750-mg dose of ciprofloxacin for 4 weeks showed enhanced eradication rates and lower inflammatory white blood cell counts compared to the 500-mg dose for 6 weeks. Our results are open to further prospective validation.

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Section: Diagnostic Proceduresmentioning

confidence: 91%

Fluoroquinolone–macrolide combination therapy for chronic bacterial prostatitis: retrospective analysis of pathogen eradication rates, inflammatory findings and sexual dysfunction

Magri¹,

Montanari²,

Škerk³

et al. 2011

Asian J Androl

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“…Possible reasons include the short treatment duration (≤12 weeks) and/or inclusion of refractory patients with previous exposure to a-blockers [57] Antibiotics CBP Despite the widespread use of antibiotics in patients with CBP and CP/CPPS, evidence in a CBP population primarily exists within RCTs or retrospective comparative trials lacking placebo control. Microbiological eradication rates were 40-77% for ciprofloxacin [65][66][67], 75% for levofloxacin [65], 80% for azithromycin [66,68,69], 77% for doxycycline [68], 80% for clarithromycin [69], and 62-77% for azithromycin + ciprofloxacin (depending on ciprofloxacin dose) [70]. Higher eradication rates (>90%) were reported with azithromycin and levofloxacin either alone, in combination or sequentially, depending on the locality of infection (urethral, prostatic or both) in patients with CBP with C. trachomatis infection [71].…”

Section: A-adrenergic Antagonistsmentioning

confidence: 99%

“…Significant differences in symptom severity, as assessed by changes in NIH-CPSI scores, were seen between baseline and the end of treatment in two trials [70,71]. Others reported improvements in clinical outcomes but failed to use validated tools to report these [65][66][67][68][69] Of the identified comparative studies in patients with CBP, one (n = 408) found that levofloxacin offered advantages over ciprofloxacin for bacterial eradication rates and clinical improvement [67], while another of similar size (n = 377) and design showed no significant differences between these agents [65]. Azithromycin was reported to be more effective than ciprofloxacin in the treatment of C. trachomatis infections [66].…”

Section: A-adrenergic Antagonistsmentioning

confidence: 99%

“…Others reported improvements in clinical outcomes but failed to use validated tools to report these [65][66][67][68][69] Of the identified comparative studies in patients with CBP, one (n = 408) found that levofloxacin offered advantages over ciprofloxacin for bacterial eradication rates and clinical improvement [67], while another of similar size (n = 377) and design showed no significant differences between these agents [65]. Azithromycin was reported to be more effective than ciprofloxacin in the treatment of C. trachomatis infections [66]. Although there is a lack of prospective, head-to-head placebo-controlled trials to assess intraclass and interclass antibiotic comparisons, each class is associated with its own advantages and caveats (Table 6).…”

Section: A-adrenergic Antagonistsmentioning

confidence: 99%

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Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline

Rees

Abrahams

Doble³

et al. 2015

BJU International

241

193

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ObjectivesTo improve awareness and recognition of chronic bacterial prostatitis (CBP) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) among non-specialists and patients. To provide guidance to healthcare professionals treating patients with CBP and CP/CPPS, in both non-specialist and specialist settings. To promote efficient referral of care between nonspecialists and specialists and the involvement of the multidisciplinary team (MDT). Patients and MethodsThe guideline population were men with CBP or CP/CPPS (persistent or recurrent symptoms and no other urogenital pathology for ≥3 of the previous 6 months). Consensus recommendations for the guidelines were based on a search to identify literature on the diagnosis and management of CBP and CP/CPPS (published between 1999 and February 2014). A Delphi panel process was used where high-quality, published evidence was lacking. ResultsCBP and CP/CPPS can present with a wide range of clinical manifestations. The four main symptom domains are urogenital pain, lower urinary tract symptoms (LUTSvoiding or storage symptoms), psychological issues and sexual dysfunction. Patients should be managed according to their individual symptom pattern. Options for first-line treatment include antibiotics, a-adrenergic antagonists (if voiding LUTS are present) and simple analgesics. Repeated use of antibiotics, such as quinolones, should be avoided if there is no obvious symptomatic benefit from infection control or cultures do not support an infectious cause. Early use of treatments targeting neuropathic pain and/or referral to specialist services should be considered for patients who do not respond to initial measures. An MDT approach (urologists, pain specialists, nurse specialists, specialist physiotherapists, general practitioners, cognitive behavioural therapists/psychologists, and sexual health specialists) is recommended. Patients should be fully informed about the possible underlying causes and treatment options, including an explanation of the chronic pain cycle. ConclusionChronic prostatitis can present with a wide variety of signs and symptoms. Identification of individual symptom patterns and a symptom-based treatment approach are recommended. Further research is required to evaluate management options for CBP and CP/CPPS.

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“…In a prospective, comparative randomized study, the efficacy and tolerability of azithromycin and ciprofloxacin were compared in the treatment of CP caused by C. trachomatis (72). The authors of this study examined a total of 89 patients with inflammatory findings and the presence of C. trachomatis in expressed prostatic secretions (EPS) or in voided bladder urine collected immediately after prostatic massage (VB3).…”

Section: Clinical Evidence Of Efficacy Of Macrolides In Prostate Infementioning

confidence: 99%

Macrolides for the treatment of chronic bacterial prostatitis: An effective application of their unique pharmacokinetic and pharmacodynamic profile (Review)

et al. 2011

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Abstract. Chronic bacterial prostatitis (CBP) is a persistent infection of the prostate characterized by poor quality of life mainly due to frequent relapse episodes caused by incomplete eradication of causative pathogens. Aggressive antibacterial therapy is required to attenuate the severe symptoms of CBP and to achieve a permanent cure. Although fluoroquinolones are currently recommended as first-choice agents, macrolide antibiotics are emerging as a noteworthy option for the treatment of CBP. Macrolide antibiotics are characteri zed by an impressive array of distinct pharmacokinetic (PK) and pharmacodynamic (PD) properties. These properties include high intracellular accumulation in phagocytes and at sites of infection, including the prostate; broad antibiotic but also biofilm-inhibiting properties; immunomodulating and inflammation-resolving activities. These features offer particular advantages for the treatment of chronic infections of the prostate gland, which are not easily amenable to drug therapy. Macrolides may be exploited to counteract the unsatisfactory rates of clinical symptom improvement and pathogen eradication. The results of a number of clinical trials support this proposal.

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Comparative analysis of azithromycin and ciprofloxacin in the treatment of chronic prostatitis caused by Chlamydia trachomatis

Cited by 36 publications

References 23 publications

Fluoroquinolone–macrolide combination therapy for chronic bacterial prostatitis: retrospective analysis of pathogen eradication rates, inflammatory findings and sexual dysfunction

Fluoroquinolone–macrolide combination therapy for chronic bacterial prostatitis: retrospective analysis of pathogen eradication rates, inflammatory findings and sexual dysfunction

Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline

Macrolides for the treatment of chronic bacterial prostatitis: An effective application of their unique pharmacokinetic and pharmacodynamic profile (Review)

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