The pH of the Prostatic Fluid in Health and Disease:Implications of Treatment in Chronic Bacterial Prostatitis

Pfau, Alphonse; Perlberg, S.; Shapira, Amos

doi:10.1016/s0022-5347(17)57497-2

Cited by 62 publications

(31 citation statements)

References 14 publications

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“…Unfortunately, few antibiotics have these necessary characteristics to be of use in the treatment of chronic prostatitis. In addition, some studies have indicated that the pH of prostatic fluid in CBP patients is alkaline rather than acidic [22, 23, 24]. The fluoroquinolones have an advantage in this respect because they are amphoteric drugs or zwitterions and thus have two pKa values, one at acid pH and one at alkaline pH.…”

Section: Principles Of Antibiotic Treatment In Chronic Prostatitismentioning

confidence: 99%

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

et al. 1998

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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.

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Section: Principles Of Antibiotic Treatment In Chronic Prostatitismentioning

confidence: 99%

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

et al. 1998

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“…The normal pH of human prostatic fluid is 6.5-6.7 [2]. In chronic prostatitis, the pH increases and ranges from 7.0 to 8.3 [4]. 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 [5].…”

Section: Introductionmentioning

confidence: 99%

“…Extensive protein binding will tend to lower the amount of free drug available for passive diffusion. Decreased protein binding of antimicrobial agents to plasma or tissue proteins may further improve their penetration into prostatic fluid [2,4,5].…”

Section: Introductionmentioning

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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“…Unfortunately, few antibiotics have these necessary characteristics to be of use in the treatment of chronic prostatitis. In addition, some studies have indicated that the pH of prostatic fluid in CBP patients is alkaline rather than acidic [22][23][24]. The fluoroquinolones have an advantage in this respect because they are amphoteric drugs or zwitterions and thus have two pKa values, one at acid pH and one at alkaline pH.…”

Section: Antibiotic Levels In Prostatic Tissuementioning

confidence: 99%

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

Johansen¹,

Gr??neberg²,

Guibert³

et al. 1999

The Journal of Urology

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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.

show abstract

The pH of the Prostatic Fluid in Health and Disease:Implications of Treatment in Chronic Bacterial Prostatitis

Cited by 62 publications

References 14 publications

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

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

Penetration of Antimicrobial Agents into the Prostate

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

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