Chronic bacterial prostatitis and antimicrobial therapy


Chronic bacterial prostatitis ( CBP ) is frequently diagnosed in men of fertile age, and is characterized by a disabling array of symptoms, including pain in the pelvic area ( for example, perineum, testicles ), voiding symptoms ( increased frequency and urgency, also at night; pain or discomfort at micturition ), and sexual dysfunction.
Cure of chronic bacterial prostatitis can be attempted by long-term therapy with antibacterial agents, but relapses are frequent. Few antibacterial agents are able to distribute to the prostatic tissue and achieve sufficient concentrations at the site of infection. These agents include fluoroquinolones, macrolides, tetracyclines and Trimethoprim.
After the introduction of fluoroquinolones into clinical practice, a number of studies have been performed to optimize the antimicrobial treatment of chronic bacterial prostatitis, and to improve eradication rates and symptom relief.

Researchers have assessed and compared the efficacy and harm of antimicrobial treatments for chronic bacterial prostatitis.

All randomized controlled comparisons of one antimicrobial agent versus placebo or one or more comparator antimicrobial agents, combined or not with non-antimicrobial drugs were included.

Researchers have identified 18 studies, enrolling a total of 2196 randomized patients. The oral fluoroquinolones Ciprofloxacin, Levofloxacin, Lomefloxacin, Ofloxacin and Prulifloxacin were compared. There were no significant differences in clinical or microbiological efficacy or in the rate of adverse effects between these fluoroquinolones.

In chlamydial prostatitis, (i) Azithromycin showed improved eradication rates and clinical cure rates compared to Ciprofloxacin, with no significant differences regarding adverse effects; (ii) Azithromycin was equivalent to Clarithromycin, both microbiologically and clinically; (iii) Prulifloxacin appeared to improve clinical symptoms, but not eradication rates, compared to Doxycycline.

In ureaplasmal prostatitis, the comparisons Ofloxacin versus Minocycline and Azithromycin versus Doxycycline showed similar microbiological, clinical and toxicity profiles.

In conclusion, the microbiological and clinical efficacy, as well as the adverse effect profile, of different oral fluoroquinolones are comparable. No conclusions can be drawn regarding the optimal treatment duration of fluoroquinolones in the treatment of chronic bacterial prostatitis caused by traditional pathogens.
Alternative antimicrobial agents tested for the treatment of chronic bacterial prostatitis caused by traditional pathogens are Co-trimoxazole, beta-lactams and tetracyclines, but no conclusive evidence can be drawn regarding the role of non-fluoroquinolone antibiotics in the treatment of chronic bacterial prostatitis caused by traditional pathogens.
In patients with chronic bacterial prostatitis caused by obligate intracellular pathogens, macrolides showed higher microbiological and clinical cure rates compared to fluoroquinolones. ( Xagena )

Perletti G et al, Cochrane Database Syst Rev 2013;8:CD009071. doi: 10.1002/14651858.CD009071.pub2

XagenaMedicine_2013



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