Monday, September 24, 2012

Important Facts Regarding Prostatitis Antibiotic Treatment

By Patrice McCoy

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.

The infections may be either acute or chronic. Acute infections are those that have a sudden onset and respond rapidly to medication. Chronic infections start gradually and remain persistent for long periods of time. They respond to therapeutic agents but tend to recur when treatment is stopped. They are more difficult to treat compared to the acute cases.

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.

If patients are not responsive after 4 weeks of treatment, treatment should be continued up to about 12 weeks of treatment. By this time a majority of patients usually have responded. Penetration of the prostate epithelium by most drugs is difficult except for those that are lipophilic. Penetration by most drugs is, however, better when the prostate is inflamed. Patients often find it challenging to remain compliant to medication for long periods of time.

Oral antibiotics are also chosen for the chronic infections. Trimethoprim/sulfamethoxazole, TMX-SMZ and fluoroquinolones are preferred. Other agents used include erythromycin, tetracycline, nitrofurantoin and carbenicillin. The dosage of TMX-SMZ is about 80-400 mg twice daily. Ciprofloxacin, a fluoroquinolone is administered at a dosage of 500 mg twice daily. Others include gatifloxacin, and ofloxacin. Cure rates range between 33 and 50% after 6 weeks of therapy.

The main side effects of TMP-SMZ are poor appetite, vomiting, diarrhoea and nausea. Fluoroquinolones are associated with tendinitis, gastrointestinal distress and tendon rupture. If there is suspected gonorrhoeal or chlamydial disease, then ciprofloxacin is preferred to TMP-SMZ. The importance of drug compliance cannot be overemphasized. Taking less of than the prescribed dosage or skipping dosages is associated with drug resistance and frequent relapses.

Very severe disease is associated with sepsis (systemic infection). Patients presenting in this manner need to be hospitalized. Broad spectrum antibiotic agents such as aminoglycosides and cephalosporins are then administered through the intravenous route. They also need to be adequately hydrated. If in pain, analgesics should also be given. Other supportive measures include the use of antipyretics (to control fever), stool softeners and catheterization to ease the passage of urine.

Prostatitis antibiotic treatment should be continued in patients with frequent relapses. They should, in addition, undergo a prostatic massage twice weekly. This will help unblock any blocked glands by draining abscesses and thus facilitate drug penetration. If this does not improve the condition, then a review by a urologist is indicated.

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