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.

Urinary tract infection in patients with spinal cord injury after urodynamics under fosfomycin prophylaxis: a retrospective analysis

“…The recommended antibiotics in chronic bacterial prostatitis, together with their advantages and disadvantages, are listed in Table 18 [263]. Fluoroquinolones, such as ciprofloxacin and levofloxacin, are considered drugs of choice because of their favourable pharmacokinetic properties [263] (LE: 2b, GR: B), their generally good safety profile, and antibacterial activity against Gram-negative pathogens, including P. aeruginosa. In addition, levofloxacin is active against Gram-positive and atypical pathogens, such as C. trachomatis and genital mycoplasmas (LE: 2b, GR: B).…”

“…In chronic bacterial prostatitis antibiotics should be given for 4-6 weeks after initial diagnosis. Relatively high doses are needed and oral therapy is preferred [263,264] (LE: 3, GR: B). If intracellular bacteria have been detected or are suspected, tetracyclines or erythromycin should be given [263,265] (LE: 2b, GR: B).…”

“…If intracellular bacteria have been detected or are suspected, tetracyclines or erythromycin should be given [263,265] (LE: 2b, GR: B). [263]. Intraprostatic injection of antibiotics This treatment has not been evaluated in controlled trials and should not be considered [266,267].…”

Management of prostatitis

“…antibiotics commonly used include quinolones (ciprofloxacin or levofloxacin), 5 gentamycin, cephalosporins, vancomycin, penicillin and trimethoprimsulfamethoxazole (TMP-SMX) alone or in combination depending on the organism(s), whereas fluoroquinolones (ciprofloxacin=levofloxacin) or TMP-SMX 5 may be used for outpatient therapy. 32 The antibiotics should be continued for 4 weeks. 5 Patients may benefit from alpha-blockers to relax the prostate and anti-inflammatory agents.…”