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.

Interventions for chronic abacterial prostatitis

“…Although experts may recommend or support an empiric course of antibiotics for chronic abacterial prostatitis (Nickel 1998a, Lipsky 1999, Bjerklund Johansen 1998), this practice is not supported by the existing evidence regarding disease etiology and treatment outcomes and deserves further scrutiny. Additionally, while a recent review has categorized alpha blocker treatment as "likely to be beneficial" in chronic abacterial prostatitis (Stern 1999), the routine use of alpha blockers was not supported by the available evidence.…”

Semen Quality in Patients With Chlamydia trachomatis Genital Infection Treated Concurrently With Prulifloxacin and a Phytotherapeutic Agent

“…All patients underwent antibiotic therapy for 14 days. In accordance with Bjerklund Johansen and co‐workers (1998), who stated that the minimum duration of antibiotic treatment should be 2–4 weeks, a 14‐day treatment course was selected in order to decrease the adverse effects related to long‐term treatment with fluoroquinolones. In addition, group B patients underwent FERTIMEV (1 vial daily for 6 months).…”

Factores que influyen en la vigilancia de la salud prostática en nuestro medio

“…Los antibióticos recomendados en la prostatitis bacteriana crónica y el SDPC inflamatorio son el ciprofloxacino y levofloxacino que se consideran fármacos de elección debido a su perfil de seguridad y a sus propiedades farmacocinéticas favorables además de poseer actividad antibacteriana frente a patógenos gramnegativos como la Pseudomona aeruginosa [194].…”