Infections of the Prostate are present in 5-10% of men with prostatitis. The organism, E. Coli, a gram-negative bacterium, is the commonest cause of these infections comprising close to 80% of the cases. The infections are commonest in younger men of between 30 and 50 years. Symptoms of infection include, among others, a painful groin, fever, painful passage of urine and reduced urine output. Prostatitis antibiotic treatment is chosen based on the type of infecting organism.
Generally the infection may be classified as acute or chronic. An acute infection starts suddenly and responds well to therapy resolving within a few days to weeks. A chronic infection, on the other hand, has a gradual onset and is often poorly responsive to therapy. Recurrences are common even if the initial episode is treated successfully.
If the history and physical examination are in favor of a tentative diagnosis of prostatitis, therapeutic agents start being administered empirically. The drugs are chosen based on the possible organisms in that clinical setting. A sample of urine is cultured in order to identify the exact organism. Once this organism has been identified, the drugs are changed as appropriate. Management of acute cases is by oral antibiotics such as cephalosporins, fluoroquinolones and aminoglycoside among others.
Patients who fail to respond to the initial course of therapy (usually 4 weeks) should be considered for longer periods of therapy. Most patients will have responded positively by about 12 weeks. Many antibiotics cannot penetrate the epithelium (lining) of the prostate except when it is inflamed. The epithelium is lipid in nature and thus more lipophilic antibiotics are preferred. The main challenge of prolonged periods of treatment is the difficult in getting patient compliance.
Chronic bacterial prostatitis or CBP is also treated with oral antimicrobial agents. Commonly used agents include fluoroquinolones and trimethoprim/sulfamethoxazole combination (TMX-SMZ). Other drugs used include tetracycline, carbenicillin, nitrofurantoin and erythromycin. TMP-SMZ is given at dosages of 80-400 mg twice daily. The fluoroquinolones used include ciprofloxacin (500mg) or ofloxacin (400mg) given twice daily. Other options include gatifloxacin (or moxifloxacin) given 400 mg once daily. 33-50% of cure rates are obtained after 4 to 6 weeks of treatment.
Like any other pharmacological agents, these drugs are associated with side effects. TMP-SMZ, for example, causes nausea, diarrhoea, vomiting poor appetite. Fluoroquinolones have a worse side effects profile that includes tendon rupture, tendinitis and gastrointestinal distress. Ciprofloxacin is the drug of choice in cases where sexually transmitted infections are also suspected. This is because it cures both Chlamydial and Gonorrhoeal infections. Drug compliance is key to successful treatment. Poor compliance is associated with long duration of treatment and progression to chronicity.
Severe infection is often characterized with sepsis and requires hospitalization. Broad spectrum antibiotics such as cephalosporins and aminoglycosides are given intravenously. These patients may also need hydration, analgesic agents, stool softeners and catheterization to relieve urinary obstructive symptoms.
Patients that have relapses may be continued on prostatitis antibiotic treatment accompanied by prostatic drainage or massage twice weekly. It is believed that this practice opens up any blocked glands with abscesses allowing them to drain normally and hence allowing penetration of antibiotics. It may be necessary to consult with a urologist in cases of chronic relapsing prostatitis. The urologist will help with localization of the organism.
Generally the infection may be classified as acute or chronic. An acute infection starts suddenly and responds well to therapy resolving within a few days to weeks. A chronic infection, on the other hand, has a gradual onset and is often poorly responsive to therapy. Recurrences are common even if the initial episode is treated successfully.
If the history and physical examination are in favor of a tentative diagnosis of prostatitis, therapeutic agents start being administered empirically. The drugs are chosen based on the possible organisms in that clinical setting. A sample of urine is cultured in order to identify the exact organism. Once this organism has been identified, the drugs are changed as appropriate. Management of acute cases is by oral antibiotics such as cephalosporins, fluoroquinolones and aminoglycoside among others.
Patients who fail to respond to the initial course of therapy (usually 4 weeks) should be considered for longer periods of therapy. Most patients will have responded positively by about 12 weeks. Many antibiotics cannot penetrate the epithelium (lining) of the prostate except when it is inflamed. The epithelium is lipid in nature and thus more lipophilic antibiotics are preferred. The main challenge of prolonged periods of treatment is the difficult in getting patient compliance.
Chronic bacterial prostatitis or CBP is also treated with oral antimicrobial agents. Commonly used agents include fluoroquinolones and trimethoprim/sulfamethoxazole combination (TMX-SMZ). Other drugs used include tetracycline, carbenicillin, nitrofurantoin and erythromycin. TMP-SMZ is given at dosages of 80-400 mg twice daily. The fluoroquinolones used include ciprofloxacin (500mg) or ofloxacin (400mg) given twice daily. Other options include gatifloxacin (or moxifloxacin) given 400 mg once daily. 33-50% of cure rates are obtained after 4 to 6 weeks of treatment.
Like any other pharmacological agents, these drugs are associated with side effects. TMP-SMZ, for example, causes nausea, diarrhoea, vomiting poor appetite. Fluoroquinolones have a worse side effects profile that includes tendon rupture, tendinitis and gastrointestinal distress. Ciprofloxacin is the drug of choice in cases where sexually transmitted infections are also suspected. This is because it cures both Chlamydial and Gonorrhoeal infections. Drug compliance is key to successful treatment. Poor compliance is associated with long duration of treatment and progression to chronicity.
Severe infection is often characterized with sepsis and requires hospitalization. Broad spectrum antibiotics such as cephalosporins and aminoglycosides are given intravenously. These patients may also need hydration, analgesic agents, stool softeners and catheterization to relieve urinary obstructive symptoms.
Patients that have relapses may be continued on prostatitis antibiotic treatment accompanied by prostatic drainage or massage twice weekly. It is believed that this practice opens up any blocked glands with abscesses allowing them to drain normally and hence allowing penetration of antibiotics. It may be necessary to consult with a urologist in cases of chronic relapsing prostatitis. The urologist will help with localization of the organism.
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