Prostatitis chronic bacterial

Acute bacterial prostatitis High fever, chills, malaise, myalgia, localized pain (perineal, rectal, sacrococcygeal), frequency, urgency, dysuria, nocturia, and retention Chronic bacterial prostatitis Voiding difficulties (frequency, urgency, dysuria), low back pain, and perineal and suprapubic discomfort Physical examination... 

Acute bacterial prostatitis Swollen, tender, tense, or indurated gland Chronic bacterial prostatitis Boggy, indurated (enlarged) prostate in most patients Laboratory tests Bacteriuria... 

Acute bacterial exacerbation of chronic bronchitis/community-acquired pneumonia/acute maxillary sinusitis/uncomplicated SSSI/chronic bacterial prostatitis... 

Treatment of acute and chronic prostatitis - 160 mg TMP/800 mg SMZ twice daily has been used for chronic bacterial prostatitis for up to 12 weeks. 

In a multicenter, prospective, randomized study of oral lomefloxacin 400 mg/day in 182 patients with chronic bacterial prostatitis, the most frequent adverse events were gastrointestinal disorders (1). 

Naber KG European Lomefloxacin Prostatitis Study Group. Lomefloxacin versus ciprofloxacin in the treatment of chronic bacterial prostatitis. Int J Antimicrob Agents 2002 20(l) 18-27. 

The remaining 20% of recurrent UTIs are relapses, i.e., persistence of infection with the same organism after therapy for an isolated UTI. The recurrence of symptomatic or asymptomatic bac-teriuria after therapy usually indicates that the patient has renal involvement, a structural abnormality of the urinary tract, or chronic bacterial prostatitis. In the absence of structural abnormalities, relapse often is related to renal infection and requires a long duration of treatment. Women who relapse after short-course therapy should receive a 2-week course of therapy. In patients who relapse after 2 weeks of therapy, therapy should be continued for another 2 to 4 weeks. If relapse occurs after 6 weeks of therapy, urologic evaluation should be performed, and any obstructive lesion should be corrected. If this is not possible, therapy for 6 months or longer may be considered. Asymptomatic adults who have no evidence of urinary obstruction should not receive long-term therapy. 

E. coli most commonly causes chronic bacterial prostatitis, with other gram-negative organisms isolated less frequently. The importance of gram-positive organisms in chronic bacterial prostatitis remains controversial. S. epidermidis, S. aureus, and diphtheroids have been isolated in some studies. 

Chronic bacterial prostatitis Voiding difficulties (frequency, urgency, dysuria), low back pain, and perineal and suprapubic discomfort Physical Examination... 

In contrast, chronic bacterial prostatitis is more difficult to diagnose and treat. Chronic bacterial prostatitis typically is characterized by recurrent UTIs with the same pathogen and is the most common cause of recurrent UTI in males. The patient s clinical presentation can vary widely (see Table 114-6). Many adults, however, are asymptomatic. 

Because physical examination of the prostate is often normal, urinary tract localization studies are critical to the diagnosis of chronic bacterial prostatitis. The method of quantitative localization culture, as described by Meares and Stamey, remains the diagnostic standard... 

Chronic bacterial prostatitis often presents a more vexing situation because cures are obtained rarely. In the past, it was recognized that despite high serum concentrations of antibacterial drugs in excess of the minimal inhibitory concentrations (MICs) of the infecting or-... 

The choice of antibiotics in chronic bacterial prostatitis should include agents that are capable of reaching therapeutic concentrations in the prostatic fluid and whch possess the spectrum of activity to be effective. Agents that achieve therapeutic prostatic concentrations include trimethoprim and the fluoroquinolones. Sulfamethoxazole penetrates poorly and probably contributes very little to trimethoprim. 

The fluoroquinolones appear to provide the best therapeutic options in the management of chronic bacterial prostatitis. Trimethoprim-sulfamethoxazole is also effective. Therapy should be continued for... 

Pfau A, Perlberg S, Shapiro A. The pH of prostatic fluid in health and disease Implications of treatment in chronic bacterial prostatitis. J Urol 1978 119 384-387. 

Ciprofloxacin is a fluoroquinolone antibiotic that interferes with microbial DNA synthesis. It is indicated in the treatment of infections of the lower respiratory tract, skin and skin structure, bones and joints, urinary tract gonorrhea, chancroid, and infectious diarrhea caused by susceptible strains of specific organisms typhoid fever uncomplicated cervical and urethral gonorrhea women with acute uncomplicated cystitis acute sinusitis nosocomial pneumonia chronic bacterial prostatitis complicated intra-abdominal infections reduction of incidence or progression of inhalational anthrax following exposure to aerosolized Bacillus anthracis. Cipro IV Used for empirical therapy for febrile neutropenic patients. 

Levofloxacin is a fluoroquinolone/ophthalmic/antibiotic that interferes with microbial DNA synthesis. It is indicated in the treatment of acute maxillary sinusitis, acute bacterial exacerbation of chronic bronchitis, nosocomial pneumonia, community-acquired pneumonia, skin and skin structure infections, chronic bacterial prostatitis, urinary tract infection (UTI), inhalational anthrax (postexposure), and acute pyelonephritis caused by susceptible strains of specific microorganisms. Ophthalmic use is for the treatment of conjunctivitis caused by susceptible strains of aerobic Gram-positive and aerobic Gram-negative microorganisms. 

Chronic bacterial prostatitis occurs when acute bacterial prostatitis has been inadequately treated because of pathogen resistance, relapse, or short-course therapy or because of blocked drainage of secretions from the prostate. Most men with chronic prostatitis will have had a previous bout of acute prostatitis. The most common clinical feature of chronic prostatitis is recurrent urinary tract infections and the symptoms and complaints of acute bacterial prostatitis. Fluoroquinolones, trimethoprim-sulfamethoxazole, doxycycline, and nitrofurantoin are used in the management of chronic prostatitis. Chronic prostatitis warrants at least 10 to 12 weeks of therapy. Poor clinical outcomes, however, have been observed because of poor diffusion of antimicrobials into the prostate. 

In 117 men who took oral levofloxacin 500 mg/day for chronic bacterial prostatitis there were six cases of musculoskeletal and connective tissue disorders (5.1%) [68 ]. 

Zhang ZC, Jin FS, Liu DM, Shen ZJ, Sun YH, Guo YL. Safety and efficacy of levofloxacin versus ciprofloxacin for the treatment of chronic bacterial prostatitis in Chinese patients. Asian J Androl 2012 14(6) 870-4. 

Acute bacterial prostatitis can be managed with many agents that have activity against the causative organism. Chronic prostatitis requires an agent that is not only active against the causative organism but also concentrates in the prostatic secretions. Therapy with trimethoprim-sulfamethoxazole or a fluoroquinolone is preferred for 4 to 6 weeks. 

Carbenicillin is an extended-spectrum penicillin, that inhibits mucopeptide synthesis in bacterial cell wall. It is indicated in the treatment of acute and chronic infections of the upper and lower urinary tract, prostatitis, and asymptomatic bacteriuria caused by susceptible microorganisms. 

Ofloxacin interferes with microbial DNA synthesis. It is indicated in the treatment of acnte bacterial exacerbations of chronic bronchitis, commnnity acquired pneumonia, uncomplicated skin and skin structure infections, acute uncomplicated urethral and cervical gonorrhea, nongonococcal urethritis, cervicitis, acute pelvic inflammatory disease, uncomplicated cystitis, complicated urinary tract infections (UTI), and prostatitis cdiV eAhy Escherichia coli. Ophthalmic use for treatment of conjunctivitis and corneal ulcer infections caused by susceptible organisms otic use for treatment of otitis externa, chronic suppurative otitis media in patients with perforated tympanic membranes, and acute otitis media in pediatric patients with tympanostomy tubes. 

Treatment of uncomplicated lower urinary tract infections with trimethoprim—sulfamethoxazole often is highly effective for sensitive bacteria, usually for a minimum of 3 days. The combination is especially useful in chronic and recurrent infections of the urinary tract. Trimethoprim also is found in therapeutic concentrations in prostatic secretions, and trimethoprim—sulfamethoxazole is often effective for bacterial prostatitis. 

Co-trimoxazole te.g., Bactrim or Septra) Inhibits the folate synthesis pathway at two different sites (Fig. 7.14). This increases the likelihood that bacteria will produce too little folate to effectively reproduce. Additionally, the likelihood of resistance is substantially reduced. Indicated for urinary tract infections, acute otitis, shigellosis, and Pneumocystis carinii pneumonitis in all age groups. In adults, it is also indicated for exacerbations of chronic bronchitis, bacterial prostatitis and traveller s diarrhea. 

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