The Role of Antibiotics in the Treatment of Chronic Prostatitis:A Consensus Statement

Abstract

Practical guidelines for the diagnosis and treatment of chronic prostatitis are presented. Chronic prostatitis is classified as chronic bacterial prostatitis (culture-positive) and chronic inflammatory prostatitis (culture-negative). If chronic bacterial prostatitis is suspected, based on relevant symptoms or recurrent UTIs, underlying urological conditions should be excluded by the following tests: rectal examination, midstream urine culture and residual urine. The diagnosis should be confirmed by the Meares and Stamey technique. Antibiotic therapy is recommended for acute exacerbations of chronic prostatitis, chronic bacterial prostatitis and chronic inflammatory prostatitis, if there is clinical, bacteriological or supporting immunological evidence of prostate infection. Unless a patient presents with fever, antibiotic treatment should not be initiated immediately except in cases of acute prostatitis or acute episodes in a patient with chronic bacterial prostatitis. The work-up, with the appropriate investigations should be done first, within a reasonable time period which, preferably, should not be longer than 1 week. During this period, nonspecific treatment, such as appropriate analgesia to relieve symptoms, should be given. The minimum duration of antibiotic treatment should be 2–4 weeks. If there is no improvement in symptoms, treatment should be stopped and reconsidered. However, if there is improvement, it should be continued for at least a further 2–4 weeks to achieve clinical cure and, hopefully, eradication of the causative pathogen. Antibiotic treatment should not be given for 6–8 weeks without an appraisal of its effectiveness. Currently used antibiotics are reviewed. Of these, the fluoroquinolones ofloxacin and ciprofloxacin are recommended because of their favourable antibacterial spectrum and pharmacokinetic profile. A number of clinical trials are recommended and a standard study design is proposed to help resolve some outstanding issues.

Concentrations of Gatifloxacin in Plasma and Urine and Penetration into Prostatic and Seminal Fluid, Ejaculate, and Sperm Cells after Single Oral Administrations of 400 Milligrams to Volunteers

“…Fluoroquinolones have already been used successfully in the treatment of chronic bacterial prostatitis (CBP) and are recommended as first-line treatment for this indication (1,6). This recommendation is based on their antibacterial activity; on their ability to penetrate into prostatic tissue, prostatic fluid, seminal fluid, and ejaculate; and on clinical studies (6).…”

567 Eviprostat has an identical effect compared to pollen extract (Cernilton) in patients with chronic prostatitis/chronic pelvic pain syndrome: A randomized, prospective study

“…Antibiotics administration is the standard treatment for chronic bacterial prostatitis [19], however, the standard treatment for CP/CPPS has not yet been established [20]. To date, various treatments for CP/CPPS have been reported, including α-blockers, antibiotics, anti-inflammatory agents, phytotherapeutics, and various other modalities [4][5][6][7][8][9][10][11][12].…”

Prostatitis

“…14,15 For initial treatment of severely ill patients, the following regimens are recommended: intravenous administration of high doses of bactericidal antimicrobials, such as aminoglycosides in combination with ampicillin, a broad spectrum penicillin in combination with a beta-lactamase inhibitor, a third-generation cephalosporin or a fluoroquinolone is required until defeverescence and normalization of associated urosepsis (this recommendation is based on treatment of complicated UTIs and urosepsis). Patients who are not severely ill or vomiting may be treated with an oral fluoroquinolone.…”

“…Patients who are not severely ill or vomiting may be treated with an oral fluoroquinolone. 14,15 Trimethoprim-sulfamethoxazole (TMP/SMX) is no longer recommended as first line empirical therapy in areas where TMP/SMX resistance for E. coli, the most frequent pathogen, is greater than 10% to 20%. [15][16][17][18][19] Treatment should continue for 2 to 4 weeks.…”

“…[13][14][15] Alpha-blockers may be considered, particularly in men with moderately severe obstructive voiding symptoms to reduce the risk of urinary retention and facilitate micturition.…”