Pharmacokinetics of Clarithromycin in the Prostate: Implications for the Treatment of Chronic Abacterial Prostatitis

Giannopoulos, Aris; Koratzanis, George; Giamarellos‐Bourboulis, Evangelos J.; Panou, Charalampos; Adamakis, Ioannis; Giamarellou, Helen

doi:10.1097/00005392-200101000-00024

Cited by 14 publications

(6 citation statements)

References 14 publications

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“…The role of bacteria different from the traditional uropathogens in the pathogenesis of prostate disease as prostatitis is a moot point (28)(29)(30)(31)(32)(33)(34). Recently, the repeated findings of P. acnes as a colonizer of human prostate have sparked a debate on its role in prostate disease.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, some of the most recent and potent antibiotics are assessed for their effects on P. acnes. Fluoroquinolones, macrolides, and trimethoprim-sulfamethoxazole all penetrate well into prostate (29,35,36), and are routinely used to treat uro-genital infections. Although neither of the substances is currently recommended in the treatment of anaerobic infections (37), our results indicate that they all might inhibit P. acnes.…”

Section: Discussionmentioning

confidence: 99%

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Antibiotic susceptibility in prostate‐derived Propionibacterium acnes isolates

Olsson¹,

Davidsson²,

Unemo

et al. 2012

APMIS

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The aim of this study was to determine antibiotic susceptibility of Propionibacterium acnes isolates from prostate. Prostate-derived P. acnes isolates (n = 24, Umeå & Örebro, Sweden, 2007-2010) and a panel of control strains (n = 25, Sweden) collected from skin and deep infections were assessed for resistance to penicillin G, piperacillin-tazobactam, imipenem, gentamicin, azithromycin, erythromycin, vancomycin, ciprofloxacin, moxifloxacin, tetracycline, tigecycline, fusidic acid, clindamycin, rifampicin, linezolid, daptomycin, trimethoprim-sulfamethoxazole, and metronidazole. In addition, the isolates were tested for inducible clindamycin resistance. All prostate derived P. acnes isolates displayed wild-type distribution of MIC-values, without evidence of acquired resistance. In the reference panel, 5 of 25 isolates had acquired macrolide resistance with cross-resistance to azithromycin, clindamycin, and erythromycin. In addition, one of these isolates was resistant to tetracycline.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Antibiotic susceptibility in prostate‐derived Propionibacterium acnes isolates

Olsson¹,

Davidsson²,

Unemo

et al. 2012

APMIS

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“…There are only few data regarding the use of josamycin and clarithromycin in chronic prostatitis cases [48,49].…”

Section: Macrolidesmentioning

confidence: 99%

Penetration of Antimicrobial Agents into the Prostate

et al. 2003

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In the present review article, the penetration of antimicrobial agents into prostatic fluid and tissue was examined. Three major factors determining the diffusion and concentration of antimicrobial agents in prostatic fluid and tissue are the lipid solubility, dissociation constant (pKa) and protein binding. The normal pH of human prostatic fluid is 6.5–6.7, and it increases in chronic prostatitis, ranging from 7.0 to 8.3. A greater concentration of antimicrobial agents in the prostatic fluid occurs in the presence of a pH gradient across the membrane separating plasma from prostatic fluid. Of the available antimicrobial agents, β-lactam drugs have a low pKa and poor lipid solubility, and thus penetrate poorly into prostatic fluid, expect for some cephalosporins, which achieve greater than or equal to the inhibitory concentration. Good to excellent penetration into prostatic fluid and tissue has been demonstrated with many antimicrobial agents, including tobramycin, netilmicin, tetracyclines, macrolides, quinolones, sulfonamides and nitrofurantoin.

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“…For example, the mean maximum concentrations of azithromycin and clarithromycin in human prostatic tissue after 500 or 750 mg oral dosing were 2.54 and 3.83 µg/ml, respectively, and were higher than plasma concentrations (about 20-and 2-fold, respectively) (29,30). Rosamicin, another macrolide with gram-negative activity, was investigated in dogs with normal and infected prostates and compared to erythromycin (31).…”

Section: Treatment Options For Chronic Bacterial Prostatitismentioning

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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Pharmacokinetics of Clarithromycin in the Prostate: Implications for the Treatment of Chronic Abacterial Prostatitis

Abstract: The oral administration of clarithromycin achieved a prostate level much higher than the minimal inhibitory concentration of clarithromycin for the intracellular pathogens of chronic prostatitis. Thus, clarithromycin may be considered for treating chronic abacterial prostatitis.

Cited by 14 publications

References 14 publications

Antibiotic susceptibility in prostate‐derived Propionibacterium acnes isolates

Antibiotic susceptibility in prostate‐derived Propionibacterium acnes isolates

Penetration of Antimicrobial Agents into the Prostate

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

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