Levofloxacin Versus Cefixime as an Empiric Treatment in Acute Bacterial Prostatitis

Abstract

Acute bacterial prostatitis (ABP) is a clinical condition frequently encountered in clinical practice, but there is a lack of consensus for the diagnosis, investigations, and treatment for this pathology. We have enrolled patients diagnosed with acute prostatitis in three academic urological centres between 2019 -2020 and followed-up prospectively their evolution under two different frequently used antibiotics-fluoroquinolones and cephalosporins, both combined or not with alpha-blockers. All patients received standard start-up treatment. A total of 154 patients were included. Both groups had similar side effects rates ranging from 8.97% to 11.84%. Both groups had similar positive urine culture 15.38% for group A, respectively 14.47% for group B. Although it is an ongoing study, we can confirm that fluoroquinolones and cephalosporins, with or without alpha-blocker, are as effective and tolerated in enhancing empirical treatment initiated at admission for patients with acute bacterial prostatitis. RezumatProstatita bacteriană acută (ABP) este o afecțiune clinică întâlnită frecvent în practică, dar există o lipsă de consens pentru standardizarea diagnosticului, a investigațiilor și pentru stabilirea tratamentului. În acest studiu prospectiv au fost înrolați pacienți diagnosticați cu prostatită acută din trei centre urologice academice în perioada 2019 -2020 și s-a urmărit evoluția sub tratamentul cu două antibiotice utilizate frecventfluorochinolone (grupul A) și cefalosporine (grupul B), ambele combinate sau nu cu alfa-blocante. Toți pacienții au primit tratament standard la internare. Au fost incluși un total de 154 de pacienți. Ambele grupuri au avut rate de efecte secundare similare, variind între 8,97% și 11,84%. Ambele grupuri au avut frecvența uroculturilor pozitive similară: 15,38% pentru grupul A, respectiv 14,47% pentru grupul B. Deși studiul este încă în desfășurare, putem confirma că fluorochinolonele și cefalosporinele, cu sau fără alfa-blocant, sunt la fel de eficiente și tolerate în îmbunătățirea tratamentului empiric inițiat la internare la pacienții cu prostatită acută bacteriană.

Antibiotic-Related Adverse Events in Hospitalized Chronic Obstructive Pulmonary Disease Patients With Frequent Exacerbation: A Retrospective Study

“…Compared to Vollenweider's review of antibiotics for exacerbations of COPD in randomized controlled trials describing side effects of antibiotics related to diarrhoea, dyspepsia, dermatological manifestations and overall, without specific neuro-psychiatric manifestations, in out/in-hospital patients [19], our study reported the rate of antibiotic-related neurological and psychiatric manifestations in patients hospitalized for recurrences of acute exacerbations of COPD. On the other hand, Tandan's meta-analysis from 2018 analysed adverse effects of fluoroquinolones versus other antimicrobials in primary care and reported central nervous system side effects of fluoroquinolones versus cefuroxime, macrolides, amoxicillin/clavulanate, or placebo [11,13]. Our study reported differences between the incidence of antibiotic-related neurological and psychiatric manifestations in the fluoroquinolone group compared to the non-fluoroquinolone group.…”

“…Romania is among the countries in the European Union that make high use of antibiotics [8]. Existing literature studies report an increased risk of side effects of antibiotics including anxiety and depression or potentiating an existing symptomatology, especially in the case of quinolones, levofloxacin and ciprofloxacin being responsible for agitation, insomnia, anxiety, panic attacks, depression, cognitive disorders and even psychotic manifestations or schizophrenic symptoms [9][10][11]. A recent study noticed a higher risk of neurologically-related adverse effects (sleep disturbances, dizziness, drowsiness, headache, tremor and asthenia) in primary care among fluoroquinolone users compared to macrolides, cefuroxime and co-amoxiclav [12].…”

“…A recent study noticed a higher risk of neurologically-related adverse effects (sleep disturbances, dizziness, drowsiness, headache, tremor and asthenia) in primary care among fluoroquinolone users compared to macrolides, cefuroxime and co-amoxiclav [12]. Other studies reported that ceftriaxone increases depressive manifestations in patients with existing symptoms of depression or can even induce new symptoms [9][10][11]13]. On the other hand, severe COPD patients are more vulnerable to neurologic or psychiatric adverse effects since they are in a state in which it is difficult to define if anxiety and depression were induced by the evolution of the disease (airflow obstruction and hypoxemia) or by antibiotic treatment, especially for those with an increased number of hospital readmissions [14] or corticoid treatment [15].…”

Antimicrobial Resistance of Ureaplasma Urealyticum and Mycoplasma Hominis in the Romanian Population

“…A statistically significant association was found between the resistant strains and the type of antibiotic (p < 0.001). This information is essential to raise awareness against using quinolones empirically for the treatment of genital infection with U. urealyticum and M. hominis [18]. Josamycin was not included in our study since it has not been used in Romania yet.…”