Chronic prostatitis: treatment with antibiotics. Treatment regimen for bacterial prostatitis Which medicine is best

The term "prostatitis" refers to the presence of inflammation in the prostate gland (PG). Chronic prostatitis is the most common urological disease causing complications in the urogenital tract. Among men aged 20–60 years, chronic prostatitis occurs in 20–30% of cases, and only 5% of them seek help from a urologist. With a long course, the clinical manifestations of chronic prostatitis, as a rule, are combined with the symptoms of vesiculitis and urethritis.

The development of chronic prostatitis is promoted by hypodynamia, decreased immunity, frequent hypothermia, impaired lymphatic circulation in the pelvic organs, persistence of various types of bacteria in the organs of the genitourinary system. In the age of computer technology, a sedentary lifestyle leads not only to prostatitis, but also to the appearance of problems from the cardiovascular system and the musculoskeletal system.

Currently, there are a large number of classifications of chronic prostatitis, but the most complete and convenient in practical terms is the classification of the American National Institutes of Health (NIH), published in 1995. According to this classification, there are four categories of prostatitis:

• I (NIH category I): acute prostatitis - acute infection of the pancreas;
• II (NIH category II): CKD is a chronic infection of the pancreas characterized by recurrent urinary tract infection;
• III (NIH category III): chronic prostatitis/chronic pelvic pain syndrome - symptoms of discomfort or pain in the pelvic area for at least 3 months. in the absence of uropathogenic bacteria detected by standard cultural methods;
• IIIA: inflammatory syndrome of chronic pelvic pain (abacterial prostatitis);
• IIIB: non-inflammatory syndrome of chronic pelvic pain (prostatodynia);
• IV (NIH category IV): asymptomatic prostatitis found in men being examined for another disease in the absence of symptoms of prostatitis.

OBP is a severe inflammatory disease and occurs spontaneously in 90% of cases or after urological manipulations in the urogenital tract.

Statistical analysis of the results of bacterial cultures found that in 85% of cases Escherichia coli and Enterococcus faecalis were sown in the bacterial culture of pancreatic secretion. Bacteria Pseudomonas aeruginosa, Proteus spp., Klebsiella spp. are much less common. Complications of OBP occur quite often, accompanied by the development of epididymitis, prostate abscess, chronic bacterial prostatitis and urosepsis. The development of urosepsis and other complications can be stopped with the rapid and effective appointment of adequate treatment.

Chronic bacterial prostatitis (CKD)

CKD is the most common urological disease among men aged 25 to 55 years, is a non-specific inflammation of the pancreas. Chronic nonspecific prostatitis occurs in approximately 20-30% of young and middle-aged men and is often accompanied by impaired copulatory and fertile functions. Complaints characteristic of chronic prostatitis disturb 20% of men aged 20 to 50 years, but only two thirds of them seek medical help [Pushkar D.Yu., Segal A.S., 2004; Nickel J. et al., 1999; Wagenlehner F.M.E. et al., 2009].

It has been established that 5-10% of men suffer from CKD, but the incidence is constantly growing.

Escherichia coli and Enterococcus faecalis predominate among the causative agents of this disease in 80% of cases, there may be gram-positive bacteria - staphylococci and streptococci. Coagulase-negative staphylococci, Ureaplasma spp., Chlamydia spp. and anaerobic microorganisms are localized in the pancreas, but their role in the development of the disease is still the subject of discussion and is not yet completely clear.

Bacteria that cause prostatitis can only be cultured in acute and chronic bacterial prostatitis. Antibacterial therapy is the mainstay of treatment, and antibiotics themselves should be highly effective.

The choice of antibiotic therapy in the treatment of chronic bacterial prostatitis is quite wide. However, the most effective are antibiotics that can easily penetrate into the prostate and maintain the required concentration for a sufficiently long time. As shown in the works of Drusano G.L. et al. (2000), levofloxacin at a dosage of 500 mg 1 time / day. creates a high concentration in the secretion of the prostate, which is maintained for a long time. The authors noted positive results using levofloxacin two days before radical prostatectomy in patients. Oral ciprofloxacin also has the property of accumulating in the prostate. The idea of ​​using ciprofloxacin has also been successfully introduced by many urologists. These schemes for the use of ciprofloxacin and levofloxacin before prostate surgery are fully justified. The high accumulation of these drugs in the prostate reduces the risk of postoperative inflammatory complications, especially against the background of persistent chronic bacterial prostatitis.

In the treatment of chronic prostatitis, of course, it is necessary to take into account the ability of antibiotics to penetrate into the prostate. In addition, the ability of some bacteria to synthesize biofilms may impair treatment outcomes. Studies on the effectiveness of antibiotics on bacteria have been studied by many authors. For example, M. Garcia–Castillo et al. (2008) conducted in vitro studies and showed that ureaplasma urealiticum and ureaplasma parvum have a good ability to form biofilms, which reduces the effectiveness of antibiotics, in particular tetracyclines, ciprofloxacin, levofloxacin and clarithromycin. Nevertheless, levofloxacin and clarithromycin effectively acted on the pathogen, having the ability to penetrate through the formed biofilms. The formation of biological films as a result of the inflammatory process makes it difficult for the antibiotic to penetrate, which reduces the effectiveness of its effect on the pathogen.

Subsequently, Nickel J.C. et al. (1995) showed the ineffectiveness of treating a model of chronic prostatitis with some antibiotics, in particular, norfloxacin. The authors 20 years ago suggested that the effect of norfloxacin is reduced due to the formation of biofilms by the bacteria themselves, which should be considered as a protective mechanism. Thus, in the treatment of chronic prostatitis, it is advisable to use drugs that act on bacteria, bypassing the formed biofilms. In addition, the antibiotic should accumulate well in the tissues of the prostate gland. Considering that macrolides, in particular clarithromycin, are ineffective in the treatment of E. coli and enterococci, in our study we opted for levofloxacin and ciprofloxacin and evaluated their effect in the treatment of chronic bacterial prostatitis.

Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS)

The etiology of CP and CPPS remains unclear in most cases. However, the analysis of the mechanisms of development of this pathology allows us to identify its main causal factors.

1. The presence of an infectious agent. DNA-containing bacterial pathogens are often found in the secretion of the prostate during examination of patients, which may indirectly indicate their pathogenicity in relation to the pancreas. The ability to restore the DNA structure of some pathogens, in particular Escherichia coli, other bacteria of the genus Enterococcus, allows microorganisms to exist for a long time in a latent state, without showing themselves. This is evidenced by the data of cultural studies. After antibiotic therapy, bacterial cultures of prostate secretion are negative. But after some time, bacteria capable of restoring their own DNA structure appear again in culture crops.
2. Violation of the function of regulation of the detrusor. The severity of dysuric phenomena may vary in different patients. HP may be completely asymptomatic. However, ultrasound data confirm the appearance of residual urine in patients with CP. This contributes to excessive stimulation of pain neuroreceptors and the appearance of a feeling of incomplete emptying of the bladder.
3. Decreased immunity. Conducted immunological studies in patients with CPP showed significant changes in the immunogram. The number of inflammatory cytokines statistically increased in most patients. At the same time, the level of anti-inflammatory cytokines was reduced, which confirmed the appearance of an autoimmune process.
4. The appearance of interstitial cystitis. Schaeffer A.J., Anderson R.U., Krieger J.N. (2006) showed an increase in the sensitivity of the potassium intravesicular test in patients with CP. But the data obtained are currently being discussed - the possibility of an isolated appearance of CP and interstitial cystitis is not ruled out.
5. Neurogenic factor in the appearance of unbearable pain. Clinical and experimental data have confirmed the source of pelvic pain, the main role in the origin of which is played by the spinal ganglia, which respond to inflammatory changes in the pancreas.
6. The appearance of venous stasis and lymphostasis in the pelvic organs. In patients with the presence of a hypodynamic factor, stagnation occurs in the pelvic organs. At the same time, venous congestion is noted. A pathogenetic relationship between the development of CP and hemorrhoids has been confirmed. The combination of these diseases occurs quite often, which confirms the general pathogenetic mechanism of the onset of diseases, based on the appearance of venous stasis. Lymphostasis in the pelvic organs also contributes to the violation of the outflow of lymph from the pancreas, and with a combination of other negative factors leads to the development of the disease.
7. The influence of alcohol. The impact of alcohol on the reproductive tract not only causes negative consequences for spermatogenesis, but also exacerbates chronic inflammatory diseases, including prostatitis.

Asymptomatic chronic prostatitis (BCP)

A chronic inflammatory process leads to a decrease in the oxygenation of prostate tissues, which not only changes the parameters of the ejaculate, but also causes damage to the structure of the cell wall and the DNA of prostate epithelial cells. This may be the reason for the activation of neoplastic processes in the pancreas.

Material and research methods

The study included 94 patients with microbiologically verified CKD (NIH category II) aged 21 to 66 years. All patients underwent a comprehensive urological examination, including filling in the CP symptom scale (NIH-CPSI), a complete blood count (CBC), microbiological and immunohistochemical examination of pancreatic secretion, PCR diagnostics to exclude atypical intracellular flora, TRUS of the prostate, and uroflowmetry. The patients were divided into two equal groups of 47 people, in the 1st group there were 39 people (83%) aged 21-50 years, in the 2nd group - 41 (87%). Group 1 as part of complex treatment received ciprofloxacin 500 mg 2 times / day. after meals, the total duration of therapy was 3-4 weeks. The second group received levofloxacin (Eleflox) 500 mg 1 time / day, the duration of treatment was 3-4 weeks on average. At the same time, patients were prescribed anti-inflammatory therapy (suppositories with indomethacin 50 mg 2 times / day for 1 week), α-blockers (tamsulosin 0.4 mg 1 time / day) and physiotherapy (magnetic laser therapy according to guidelines). Clinical control was carried out during the entire period of treatment of patients. Laboratory (bacteriological) quality control of treatment was carried out after 4–5 weeks. after taking the drug.

results

Clinical assessment of treatment results was carried out on the basis of complaints, objective examination and ultrasound data. In both groups, the majority of patients showed signs of improvement after 5–7 days from the start of treatment. Further therapy with levofloxacin (Eleflox) and ciprofloxacin showed the effectiveness of treatment in both groups.

Patients of the 1st group showed a significant decrease and disappearance of symptoms, as well as normalization of the number of leukocytes in the secretion of the pancreas, an increase in the maximum volumetric flow rate of urine according to uroflowmetry (from 15.4 to 17.2 ml/s). The average score on the NIH-CPSI scale decreased from 41.5 to 22. The prescribed therapy was well tolerated by patients. 3 patients (6.4%) developed side effects from the gastrointestinal tract (nausea, upset stool) associated with taking the antibiotic.

In patients of the 2nd group treated with ciprofloxacin, there was a decrease or complete disappearance of complaints. The maximum volumetric flow rate of urine according to uroflowmetry increased from 16.1 to 17.3 ml/s. The mean NIH-CPSI score decreased from 38.5 to 17.2. Side effects were noted in 3 (6.4%) cases. Thus, we did not obtain significant differences based on clinical observation of both groups.

In the control bacteriological examination of the 1st group of 47 patients treated with levofloxacin, eradication of pathogens was achieved in 43 (91.5%).

During treatment with ciprofloxacin, the disappearance of the bacterial flora in the prostate secretion was observed in 38 (80%) patients.

Conclusion

To date, fluoroquinolones II and III generations, related to broad-spectrum antibacterial drugs, continue to be effective antimicrobial agents for the treatment of urological infections.

The results of clinical studies did not reveal a significant difference between the use of levofloxacin and ciprofloxacin. Good tolerability of drugs allows them to be used for 3-4 weeks. However, data from bacteriological studies showed the greatest antimicrobial efficacy of levofloxacin compared to ciprofloxacin. In addition, the daily dosage of levofloxacin is provided by a single dose of the tablet form of the drug, while patients must take ciprofloxacin twice a day.

Literature

1. Pushkar D.Yu., Segal A.S. Chronic abacterial prostatitis: modern understanding of the problem // Medical class. - 2004. - No. 5–6. – P. 9–11.
2. Drusano G.L., Preston S.L., Van Guilder M., North D., Gombert M., Oefelein M., Boccumini L., Weisinger B., Corrado M., Kahn J. A population pharmacokinetic analysis of the penetration of the prostate by levofloxacin . Antimicrobial Agents Chemother. 2000 Aug;44(8):2046-51
3. Garcia-Castillo M., Morosini M.I., Galvez M., Baquero F., del Campo R., Meseguer M.A. Differences in biofilm development and antibiotic susceptibility among clinical Ureaplasma urealyticum and Ureaplasma parvum isolates. J Antimicrob Chemother. 2008 Nov;62(5):1027-30.
4. Schaeffer A.J., Anderson R.U., Krieger J.N. The assessment and management of male pelvic pain syndrome, including prostatitis. In: McConnell J, Abrams P, Denis L, et al., editors. Male Lower Uninary Tract Dysfunction, Evaluation and Management; 6th International Consultation on New Developments in Prostate Cancer and Prostate Disease. Paris: Health Publications; 2006.pp. 341–385.
5. Wagenlehner F. M. E., Naber K. G., Bschleipfer T., Brahler E.,. Weidner W. Prostatitis and Male Pelvic Pain Syndrome Diagnosis and Treatment. Dtsch Arztebl Int. March 2009; 106(11): 175–183
6. Nickel J.C., Downey J., Feliciano A.E. Jr., Hennenfent B. Repetitive prostatic massage therapy for chronic refractory prostatitis: the Philippine experience. Tech Urol. 1999 Sep;5(3):146-51
7. Nickel J.C., Downey J., Clark J., Ceri H., Olson M. Antibiotic pharmacokinetics in the inflamed prostate. J Urol. 1995 Feb;153(2):527-9
8. Nickel J.C., Olson M.E., Costerton J.W. Rat model of experimental bacterial prostatitis. infection. 1991;19(Suppl 3):126–130.
9. Nelson W.G., DeMarzo A.M., DeWeese T.L., Isaacs W.B. The role of inflammation in the pathogenesis of prostate cancer. J Urol. 2004;172:6–11.
10. Weidner W., Wagenlehner F.M., Marconi M., Pilatz A., Pantke K.H., Diemer T. Acute bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: andrological implications. Andrologia. 2008;40(2):105–112.

Many men drink antibiotics for prostatitis without the knowledge of the doctor, not knowing the causes of the disease and the characteristics of its course. This leads to the ineffectiveness of self-therapy, the development of resistance of pathogens and other undesirable consequences. The feasibility of prescribing antibacterial agents is determined by the attending physician based on the results of the studies.

When Antimicrobials Are Necessary

Not every patient with prostatitis needs antibiotics. For their appointment, laboratory diagnostics is carried out, confirming the presence of the bacterial nature of the disease. The infection happens:

1. Primary. When a pathogen causes disease.
2. Secondary. If the infection has joined after the development of the inflammatory process.

• trauma;
• overweight;
• circulatory disorders in the pelvic area;
• hypothermia;
• passive lifestyle;
• associated diseases of the genitourinary system.

Bacteria are able to adapt to environmental changes. If antimicrobial agents are taken in violation of dosages or too often, microorganisms get used to the medicine. The next treatment with the same drug will be ineffective. A man will need to prescribe other drugs that have a greater toxic effect on the body, mainly on the kidneys and liver.

To accurately determine whether antibacterial medications are needed for prostatitis or not, you need to come to the hospital and undergo an examination. Initially, the doctor palpates the gland through the anus, after which he writes out a direction for:

• general analysis of blood and urine;
• culture of urine and prostate secretions;
• scraping from the urethra;
• determination of the level of prostate-specific antigen, which is the primary criterion for the detection of prostate cancer;
• Organ ultrasound.

1. If the patient independently took antimicrobial tablets, then the culture is clean. After a while, the pathology returns and is more difficult to treat. If the fact of self-administration of antibiotics was present, it is necessary to tell the doctor about it. This will save both of them time.
2. Sometimes it happens that prostatitis is non-infectious in nature, but pathogenic microorganisms are found in the urethra. In this case, the use of antibacterial agents is necessary. It will eliminate pathogens and prevent secondary infection of the prostate.
3. Less common cause of inflammation is tuberculosis. Contrary to popular belief, it affects not only the lungs and bones, but also the tissue of the male gland. Often the infection is hidden and spreads to the seminal vesicles, bladder.

• tetracyclines;
• penicillins;
• macrolides;
• fluoroquinolones;
• cephalosporins.

• drugs that improve blood circulation in the pelvis;
• anti-inflammatory tablets, injections, ointments or suppositories of non-steroidal origin;
• antidepressants, psychostimulants;
• medical gymnastics;
• lifestyle adjustments;
• vitamin complexes to strengthen immunity.

• Tetracycline;
• doxycycline;
• minocycline;
• Metacycline;
• Hyoxysone;
• Oxycyclosol;
• Hyoxysone and others.

• isoxazolylpenicillins - effective in eliminating staphylococci (Nafcillin, Oxacillin);
• aminopenicillins have a wide spectrum of action (Ampicillin, Amoxicillin);
• ureidopenicillins, carboxypenicillins destroy Pseudomonas aeruginosa (Piperacillin, Ticarcillin).

Antibiotics of the penicillin series are contraindicated in persons allergic to mold.

Names of macrolide drugs:

• Azitrox;
• Azithromycin;
• Clarithromycin;
• Klacid;
• Roxylor;
• Rulid;
• Sumamed;
• Erythromycin and others.

• violation of the digestive tract;
• pathology of the central nervous system;
• negative impact on the musculoskeletal system;
• toxic damage to the kidneys and liver;
• allergic reactions.

• Pefloxacin;
• Gemifloxacin;
• Tsiprolet;
• Microflox;
• Norilet and others.

Cephalosporins

These drugs cope with microbes, damaging their cell wall, which leads to the death of the latter. Cephalosporins are effective against many pathogens, but are poorly absorbed from the gastrointestinal tract, so they are often prescribed as injections. The drugs have relatively low toxicity and are well tolerated by patients when used correctly. They are often prescribed for inpatient treatment.

The cephalosporin series is represented by drugs of 5 generations, which differ greatly in their spectrum of action. The first generation is effective against gram-positive representatives of the bacterial world. Slightly affects gram-negatives. But fifth-generation drugs are effective for the treatment of strains resistant to the penicillin group.

• Cefuroxime;
• Ceftriaxone;
• Cefaclor;
• Cefoperazone;
• Ceftobiprol.

It is extremely important to start treatment of prostatitis at the first symptoms of its occurrence. One method is to use antibiotics for this delicate problem.

Lack of treatment can lead to the development of more serious diseases, including infertility, prostate adenoma. In rare cases, malignant tumors in the prostate gland occur.

Treatment

There are several main methods of treatment:

• antibiotic therapy;
• phytotherapy;
• physiotherapy;
• massage;
• vitamin therapy and immunostimulation.

However, the use of any one method will not give a high-quality and quick result, therefore the treatment must be comprehensive.

The most important and effective is the treatment of prostatitis with antibiotics, although some patients are quite negative about drugs in this category. However, it is antibiotics that are able to quickly and effectively destroy the pathogenic flora that causes the development of prostatitis.

Important! However, in order to choose the most effective medicine, a specialist needs to conduct a series of tests that will help identify the cause of the disease.

Prostatitis, depending on the pathogen, is of two main types:

• bacterial.

Abacterial prostatitis

This disease is often referred to as chronic pelvic pain syndrome. The causes of abacterial prostatitis are not completely understood, however, most likely it develops against the background of neglected (undertreated) inflammation in the pelvic organs.

Antibiotics in the treatment of this form of prostatitis are used as a test drug. Sometimes they have some positive effect, however, as with the bacterial form of the disease, treatment must be comprehensive to achieve maximum results.

The most effective in the treatment of this form of prostatitis are quinolones. This is a fairly large group of synthetic antibiotics that have a powerful bactericidal effect on the body. The duration of medication is 10-14 days, depending on the severity of the disease.

Bacterial prostatitis

This form of inflammation of the prostate requires the mandatory use of antibiotics. However, for the fastest achievement of the result, it is necessary to initially isolate the causative agent of the disease, and in accordance with this, select the drug.

The main pathogens and their susceptibility to antibiotic groups.

To determine the causative agent of the disease, a clinical blood test, a bacterial urinalysis, an analysis of prostate secretion, and PRC diagnostics are performed. The fastest analysis of the PRC is done - and on its basis, the urologist can prescribe broad-spectrum antibiotics.

What is the best medicine?

It is quite difficult to answer the question of which drug best helps with prostatitis. Much depends on the causative agent of the disease, its form (acute, chronic), the general condition of the patient. Consider the main groups of antibiotics and their effects on the body.

Fluoroquinolones

Drugs belonging to this group of antibiotics are characterized by good bioavailability, pharmacokinetics. A high concentration of the drug in the prostate tissue is achieved quite quickly - thanks to this, a positive effect in the treatment also quickly manifests itself. The drugs actively affect a significant number of aerobic and anaerobic pathogens.

However, these drugs are not suitable for patients with impaired liver and kidney function. The drugs have increased neuro- and phototoxicity. Treatment with fluoroquinolones is prescribed only after tests are ready confirming that the patient does not have tuberculosis.

Here are some group antibiotics and their dosage:

• Norfloxacin - twice a day, 200 mg;
• Ofloxacin - a single dose of 800 mg / day;
• Ciprofloxacin - 500 mg / day;
• Levofloxacin - 500 mg / day;
• Sparfloxacin - twice a day, 200 mg.

Available in the form of tablets and powder for parenteral administration (intramuscular and intravenous injections). Some drugs, for example, ofloxacin and ciprofloxacin, are available in the form of tablets with a prolonged duration of action (they have the prefix OD in the name - Cifran Od). Such a tablet dissolves in the body for a longer time, providing a stable effect of the drug throughout the day.

Important: the drug and the antibiotic treatment regimen should be selected exclusively by a specialist who takes into account your state of health. All medicines have contraindications and side effects, so self-medication can lead to undesirable consequences.

Macrolides

In some cases, antibiotics of this group may be ineffective. This is due to the fact that the drugs do not have the necessary effect on gram-negative bacteria.

However, these antibiotics for infectious prostatitis are recommended because they have an active effect on gram-positive bacteria, chlamydia, mycoplasma. In addition, unlike most other groups of drugs, macrolide antibiotics have a much lower toxic effect on the body.

The most common:

• Azithromycin - the recommended dosage - on days 1-3 of treatment, take 1000 mg / day, then 500 mg / day.
• Clarithromycin - twice a day for 500-700 mg., Depending on the severity of the disease.
• Roxithromycin - a daily dose of the drug 300 mg.
• Josamycin - a daily dose of 1000-1500 mg., Divided into three doses.

Tetracyclines

It is believed that antibiotics of this group are most effective in the treatment of prostatitis caused by chlamydia and mycoplasma. However, recently, experts will prescribe drugs of this group quite rarely, since they have a significant number of side effects, in particular, they cause a spermotoxic effect in patients. To conceive, a man should wait at least 4-5 months after the last medication in this group.

The most common:

• Tetracycline - 250 mg. 4 times a day (every 6 hours).
• Doxycycline (Unidox Solutab) - twice a day, 100 mg.

Cephalosporins

A group of antibiotics that will be effective for diseases caused by anaerobic infections, gram-positive or gram-negative bacteria. Antibiotics of the group are available in powder form for intramuscular injection. The most common is ceftriaxone.

It is not recommended to use in patients who have impaired kidney and liver function. If ceftriaxone is the most appropriate drug, patients with impaired liver and kidney function should regularly check its plasma concentration.

Common:

• Ceftriaxone - 1000 mg. administered parenterally once a day.
• Cefuroxime - 750 mg. three times a day.
• Klaforan - 1000-2000 mg. three times a day.
• Cefotaxime - 1000-2000 mg. 2-4 times a day.

Penicillins

They have a wide range of activities. The most common "representative" of the group is. This antibiotic is often recommended at the diagnostic stage, when the results of laboratory tests aimed at identifying the causative agent of the disease are not yet ready. Penicillins are available in the form of tablets, powders for injection, suspensions.

The most common:

• Amoxiclav - 1 tablet 3 times a day.
• Amoxicillin - 250-500 mg. 2-3 times a day.

Aminoglycosides

Assign if it was not possible to identify the causative agent of the disease, or the analysis showed the presence of several pathogens at once. The antibiotic accumulates in the tissues of the prostate gland, quickly coping with the pathogen.

Common:

• Gentamicin - for intramuscular and intravenous injections, the daily dose is 3-5 ml.
• Kanamycin - for injection, a single dose - 500 mg, is administered 2-4 times a day, depending on the severity of the disease.
• 5-NOC - a single dose is 100-200 mg, taken 4 times a day.

Treatment of chronic prostatitis

In chronic prostatitis, antibiotics are also an integral part of the course of treatment, the duration of therapy is usually 2-4 weeks.

At the same time, the urologist can prescribe several different antibiotics at once - this approach is necessary if the chronic inflammatory process is caused not by a specific pathogen, but by their combination.

Most often, chronic prostatitis is treated with a group of macrolides and fluoroquinolones. They are most effective both during the period of exacerbation of the disease and during remission.

What other treatments are there?

Often, patients are recommended the drug Safocid. Its distinguishing feature is that the package contains 4 tablets. These are three different antibiotics (secnidazole, fluconazole,) intended for a single dose. This combination has the maximum effect in the treatment of both acute and chronic forms.

Rifampicin is also worth noting - these are suppositories with an antibiotic that effectively fight the causative agent of the disease, and also have a local anesthetic effect (an antispasmodic acts as an auxiliary component).

Features of antibiotic therapy

Treatment of prostatitis with antibiotics requires strict adherence to all prescriptions of a specialist. It is very important not to interrupt the course of treatment soon after improvement occurs. To completely destroy the causative agent of the disease, a long-term exposure to drugs is necessary.

If you interrupt the course, the body instantly develops resistance to active substances. And in this case, with the reappearance of signs of prostatitis, the previously taken antibiotic will not have the proper effect.

Treatment with medicines is carried out at home and rarely requires hospitalization. However, the patient should regularly visit the urologist to monitor the dynamics.

It is also necessary to completely abandon alcoholic beverages (about in more detail). This is extremely important because alcohol reduces the effectiveness of individual drugs. In addition, when taking antibiotics and drinking alcohol, the load on the liver increases significantly. This can lead to a number of diseases.

Video: treatment without antibiotics

Side effects

1. They have a significant number of side effects, in particular, most of them are observed from the gastrointestinal tract. After taking the drugs, patients experience dysbacteriosis, problems with stools, pain in the intestines, bloating. Therefore, the specialist also prescribes drugs that will help protect and restore the intestinal flora.
2. Parenterally administered medicines have a more gentle effect on the body - they do not harm the digestive system. The same can be said about rectal suppositories.
3. All groups of antibiotics, without exception, the patient may experience an allergic reaction. Therefore, it is extremely important to inform the attending physician about this when the first signs of allergy occur (skin rash, swelling, anaphylactic shock) - the patient will be given a drug from another group.

Caused by bacteria, may be acute or chronic. It develops during reproduction in the tissues of this organ of opportunistic or pathogenic microflora. The disease becomes chronic in cases where insufficient attention has been paid to the treatment of acute prostatitis. Also, this problem is faced by those men who lead a sedentary lifestyle, abuse alcohol and smoke.

Problem symptoms

Every man on the onset of pain can suspect acute bacterial prostatitis. Treatment in this case is reduced to long-term use of antibiotics, anti-inflammatory and painkillers. But diagnosing the chronic form of bacterial prostatitis is somewhat more difficult.

The disease may be accompanied by symptoms such as:

• periodic pains of varying intensity in the perineum, testicles, above the womb, in the sacrum, rectum;
• frequent urination;
• weak or interrupted urine stream;
• pain during urination;
• discomfort during ejaculation;
• erection problems.

Men suffering from chronic prostatitis may have only some of these symptoms. Signs of the disease are so subtle that many do not pay attention to them.

Diagnosis of the disease

Only a doctor can establish an accurate diagnosis and choose which treatment regimen for bacterial prostatitis will be most appropriate. He can make a differential diagnosis and exclude other diseases whose symptoms are similar. It is necessary to exclude the possibility of developing urinary tract infections, bladder cancer, prostate hyperplasia, inguinal hernia and other diseases.

A digital rectal examination is used to determine the size, shape, consistency, and degree of tenderness of the prostate gland. This method also allows differential diagnosis with cancer, prostate obstruction and acute prostatitis.

To clarify the diagnosis, urine is taken for analysis. For diagnosis, it is necessary to conduct microscopy and culture of prostate secretion. Also, experts do sowing from 3 servings of urine. Based on the results of the tests, a specific form of the disease can be determined.

In some cases, ultrasound can help identify chronic bacterial prostatitis. Doctors prescribe a course of treatment, focusing on the tests and results of examinations. Ultrasound allows you to identify stones, determine the degree to see its contours.

Reasons for the development of chronic prostatitis

Bacterial damage to the prostate occurs due to ingestion into its tissues. The disease is caused by staphylococci, streptococci, Pseudomonas aeruginosa, fecal enterococci. Also, prostatitis can begin due to the ingestion of chlamydia, Klebsiella, Trichomonas and other pathogenic microorganisms.

But chronic prostatitis occurs not only against the background of an infectious lesion. The following factors can lead to its development:

• hypothermia;
• passive lifestyle;
• stress, lack of sleep and other causes that weaken the immune system;
• irregular sex life (impairs blood flow in the tissues of the prostate);
• hormonal changes.

Are susceptible to the development of chronic bacterial prostatitis men:

• after operations on the pelvic organs;
• after catheterization;
• those who prefer anal sex without using barrier contraceptives;
• suffering from constriction of the foreskin.

Untreated acute bacterial prostatitis can become chronic.

The choice of therapy tactics

If the doctor diagnosed it will last quite a long time. Men should be prepared for the fact that only 30% of patients manage to get rid of this problem. The rest, subject to all recommendations, may enter a period of protracted remission. But almost half of all patients relapse.

Treatment for acute bacterial prostatitis usually lasts 2 weeks. Properly selected medicines make it possible to destroy everything during this period. When the disease passes into a chronic form, it becomes more difficult to get rid of it. Treatment should be aimed at eliminating all factors that contribute to maintaining the disease in a protracted, sluggish form.

Antibacterial therapy becomes more effective if alpha-blockers are used simultaneously, which affect receptors in prostate tissue. Prostate massage and physiotherapy are also effective. They should be aimed at stimulating the nerve endings of the prostate tissue and activating the clogged mucous ducts that are involved in spermagenesis.

Selection of antibacterial drugs

Only a doctor should choose the means that will help the patient get rid of chronic prostatitis. Antibiotics from the group of fluorinated quinols are often prescribed for treatment. These are such means as Ofloxacin, Sparfloxacin, Ciprofloxacin, Lomefloxacin.

In case of individual intolerance or insensitivity to these antibiotics, the doctor selects other drugs for the treatment of bacterial prostatitis. The list of funds can be expanded with antibiotics belonging to the group of macrolides. These are drugs such as Erythromycin, Clarithromycin, Josamycin, Roxithromycin. In some cases, Doxycycline is prescribed. It is an antibiotic belonging to the tetracycline group.

Comprehensive approach to treatment

To get rid of prostatitis or to achieve a long-term remission, antibiotics can be prescribed for a period of 4 to 6 weeks. If a man has frequent relapses, or the disease is not treatable, then he is prescribed antibacterial drugs in minimal prophylactic doses for a long period.

In addition, treatment with alpha-1-blockers is recommended. They must be taken within 3 months. This helps to reduce discomfort in the pelvic area and increase the volumetric flow rate of urine in patients who have been diagnosed with chronic bacterial prostatitis. Treatment improves their quality of life. Doctors may prescribe Alfuzosin, Doxazosin, or Tamsulosin.

Physiotherapy procedures

Drug treatment is mandatory when chronic prostatitis is detected. But prostate massage and special physiotherapy procedures will help alleviate the condition and reduce the manifestations of the disease. These methods are aimed at improving blood circulation in the tissues.

Massage allows you to reduce unpleasant symptoms, because it helps to eliminate the stagnation of the secretion, reduce inflammation. After it, libido rises, potency improves even in those who have been worried about bacterial prostatitis for a long time.

Treatment becomes more effective with the appointment of physiotherapy. The doctor may recommend microclysters from decoctions of chamomile, calendula or other herbs. Also prescribe an electromagnet, electrophoresis, ultrasonic effects on prostate tissue. Light therapy is also used for treatment. Infrared radiation improves metabolic processes and blood circulation, thereby reducing pain. Ultraviolet is able to activate the immune system. It also promotes the resorption of infiltrates.

Preventive methods

Preventing the development of chronic prostatitis is within the power of every man. To do this, you just need to follow all the doctor's recommendations and not try to get rid of the disease using alternative methods. Treatment of bacterial prostatitis with folk remedies can be carried out in consultation with the urologist in combination with the prescribed antibiotic therapy.

You can also alleviate the condition, if you do not forget what provokes the development of the disease. Men should:

• avoid hypothermia;
• have regular sex life;
• use barrier methods of contraception with casual partners;
• stick to a diet;
• exclude alcohol.

Nutrition must be balanced. Spicy dishes, flour products, rich broths, spices are excluded from the diet. The menu should include foods that improve digestion and help soften feces.

Possible Complications

Many refuse antibiotic therapy and prescribed procedures after they find out that they have chronic bacterial prostatitis. Treatment (drugs for which should be selected only by a doctor) they consider optional. But at the same time, they forget that chronic prostatitis can lead to the development of a number of serious problems. Among them:

• infertility;
• erection problems;
• inflammation of the testicles, seminal vesicles, testicular appendages;
• sclerosis of the prostate;
• fistula formation;
• BPH;
• the formation of cysts and stones in the tissues of the prostate.

You can prevent the development of such complications if you regularly go to the doctor and see if bacterial prostatitis has reappeared. Treatment of the chronic form does not always lead to complete recovery. But it can eliminate all the unpleasant manifestations of the disease. In this case, the patient enters a state of stable remission.

For citation: Dendeberov E.S., Logvinov L.A., Vinogradov I.V., Kumachev K.V. The tactics of choosing a treatment regimen for bacterial prostatitis // BC. 2011. No. 32. S. 2071

The term "prostatitis" refers to the presence of inflammation in the prostate gland (PG). Chronic prostatitis is the most common urological disease causing complications in the urogenital tract. Among men aged 20-60 years, chronic prostatitis occurs in 20-30% of cases, and only 5% of them seek help from a urologist. With a long course, the clinical manifestations of chronic prostatitis, as a rule, are combined with the symptoms of vesiculitis and urethritis.

The development of chronic prostatitis is promoted by hypodynamia, decreased immunity, frequent hypothermia, impaired lymphatic circulation in the pelvic organs, persistence of various types of bacteria in the organs of the genitourinary system. In the age of computer technology, a sedentary lifestyle leads not only to prostatitis, but also to the appearance of problems from the cardiovascular system and the musculoskeletal system.
Currently, there are a large number of classifications of chronic prostatitis, but the most complete and convenient in practical terms is the classification of the American National Institutes of Health (NIH), published in 1995. According to this classification, there are four categories of prostatitis:
. I (NIH category I): acute prostatitis - acute infection of the pancreas;
. II (NIH category II): CKD - ​​chronic infection of the pancreas, characterized by recurrent urinary tract infection;
. III (NIH category III): chronic prostatitis/chronic pelvic pain syndrome - symptoms of discomfort or pain in the pelvic area for at least 3 months. in the absence of uropathogenic bacteria detected by standard cultural methods;
. IIIA: inflammatory syndrome of chronic pelvic pain (abacterial prostatitis);
. IIIB: non-inflammatory syndrome of chronic pelvic pain (prostatodynia);
. IV (NIH category IV): asymptomatic prostatitis found in men being examined for another disease in the absence of symptoms of prostatitis.
Acute bacterial
prostatitis (OPP)
OBP is a severe inflammatory disease and occurs spontaneously in 90% of cases or after urological manipulations in the urogenital tract.
Statistical analysis of the results of bacterial cultures found that in 85% of cases Escherichia coli and Enterococcus faecalis were sown in the bacterial culture of pancreatic secretion. Bacteria Pseudomonas aeruginosa, Proteus spp., Klebsiella spp. are much less common. Complications of OBP occur quite often, accompanied by the development of epididymitis, prostate abscess, chronic bacterial prostatitis and urosepsis. The development of urosepsis and other complications can be stopped with the rapid and effective appointment of adequate treatment.
Chronic bacterial
prostatitis (CKD)
CKD is the most common urological disease among men aged 25 to 55 years, is a non-specific inflammation of the pancreas. Chronic nonspecific prostatitis occurs in approximately 20-30% of young and middle-aged men and is often accompanied by impaired copulative and fertile functions. Complaints characteristic of chronic prostatitis disturb 20% of men aged 20 to 50 years, but only two thirds of them seek medical help [Pushkar D.Yu., Segal A.S., 2004; Nickel J. et al., 1999; Wagenlehner F.M.E. et al., 2009].
It has been established that 5-10% of men suffer from CKD, but the incidence is constantly growing.
Among the causative agents of this disease in 80% of cases, Escherichia coli and Enterococcus faecalis predominate, there may be gram-positive bacteria - staphylococci and streptococci. Coagulase-negative staphylococci, Ureaplasma spp., Chlamydia spp. and anaerobic microorganisms are localized in the pancreas, but their role in the development of the disease is still the subject of discussion and is not yet completely clear.
Bacteria that cause prostatitis can only be cultured in acute and chronic bacterial prostatitis. Antibacterial therapy is the mainstay of treatment, and antibiotics themselves should be highly effective.
The choice of antibiotic therapy in the treatment of chronic bacterial prostatitis is quite wide. However, the most effective are antibiotics that can easily penetrate into the prostate and maintain the required concentration for a sufficiently long time. As shown in the works of Drusano G.L. et al. (2000), levofloxacin at a dosage of 500 mg 1 time / day. creates a high concentration in the secretion of the prostate, which is maintained for a long time. The authors noted positive results using levofloxacin two days before radical prostatectomy in patients. Oral ciprofloxacin also has the property of accumulating in the prostate. The idea of ​​using ciprofloxacin has also been successfully introduced by many urologists. These schemes for the use of ciprofloxacin and levofloxacin before prostate surgery are fully justified. The high accumulation of these drugs in the prostate reduces the risk of postoperative inflammatory complications, especially against the background of persistent chronic bacterial prostatitis.
In the treatment of chronic prostatitis, of course, it is necessary to take into account the ability of antibiotics to penetrate into the prostate. In addition, the ability of some bacteria to synthesize biofilms may impair treatment outcomes. Studies on the effectiveness of antibiotics on bacteria have been studied by many authors. Thus, M. Garcia-Castillo et al. (2008) conducted in vitro studies and showed that ureaplasma urealiticum and ureaplasma parvum have a good ability to form biofilms, which reduces the effectiveness of antibiotics, in particular tetracyclines, ciprofloxacin, levofloxacin and clarithromycin. Nevertheless, levofloxacin and clarithromycin effectively acted on the pathogen, having the ability to penetrate through the formed biofilms. The formation of biological films as a result of the inflammatory process makes it difficult for the antibiotic to penetrate, which reduces the effectiveness of its effect on the pathogen.
Subsequently, Nickel J.C. et al. (1995) showed the ineffectiveness of treating a model of chronic prostatitis with some antibiotics, in particular, norfloxacin. The authors 20 years ago suggested that the effect of norfloxacin is reduced due to the formation of biofilms by the bacteria themselves, which should be considered as a protective mechanism. Thus, in the treatment of chronic prostatitis, it is advisable to use drugs that act on bacteria, bypassing the formed biofilms. In addition, the antibiotic should accumulate well in the tissues of the prostate gland. Considering that macrolides, in particular clarithromycin, are ineffective in the treatment of E. coli and enterococci, in our study we opted for levofloxacin and ciprofloxacin and evaluated their effect in the treatment of chronic bacterial prostatitis.
Chronic prostatitis/syndrome
chronic pelvic pain (CP/CPPS)
The etiology of CP and CPPS remains unclear in most cases. However, the analysis of the mechanisms of development of this pathology allows us to identify its main causal factors.
1. The presence of an infectious agent. DNA-containing bacterial pathogens are often found in the secretion of the prostate during examination of patients, which may indirectly indicate their pathogenicity in relation to the pancreas. The ability to restore the DNA structure of some pathogens, in particular Escherichia coli, other bacteria of the genus Enterococcus, allows microorganisms to exist for a long time in a latent state, without manifesting themselves. This is evidenced by the data of cultural studies. After antibiotic therapy, bacterial cultures of prostate secretion are negative. But after some time, bacteria capable of restoring their own DNA structure reappear in culture crops.
2. Violation of the function of regulation of the detrusor. The severity of dysuric phenomena may vary in different patients. HP may be completely asymptomatic. However, ultrasound data confirm the appearance of residual urine in patients with CP. This contributes to excessive stimulation of pain neuroreceptors and the appearance of a feeling of incomplete emptying of the bladder.
3. Reduced immunity. Conducted immunological studies in patients with CPP showed significant changes in the immunogram. The number of inflammatory cytokines statistically increased in most patients. At the same time, the level of anti-inflammatory cytokines was reduced, which confirmed the appearance of an autoimmune process.
4. The appearance of interstitial cystitis. Schaeffer A.J., Anderson R.U., Krieger J.N. (2006) showed an increase in the sensitivity of the potassium intravesicular test in patients with CP. But the data obtained are currently being discussed - the possibility of an isolated appearance of CP and interstitial cystitis is not ruled out.
5. Neurogenic factor in the appearance of unbearable pain. Clinical and experimental data have confirmed the source of pelvic pain, the main role in the origin of which is played by the spinal ganglia, which respond to inflammatory changes in the pancreas.
6. The appearance of venous stasis and lymphostasis in the pelvic organs. In patients with the presence of a hypodynamic factor, stagnation occurs in the pelvic organs. At the same time, venous congestion is noted. A pathogenetic relationship between the development of CP and hemorrhoids has been confirmed. The combination of these diseases occurs quite often, which confirms the general pathogenetic mechanism of the onset of diseases, based on the appearance of venous stasis. Lymphostasis in the pelvic organs also contributes to the violation of the outflow of lymph from the pancreas, and with a combination of other negative factors leads to the development of the disease.
7. Influence of alcohol. The impact of alcohol on the reproductive tract not only causes negative consequences for spermatogenesis, but also exacerbates chronic inflammatory diseases, including prostatitis.
Asymptomatic
chronic prostatitis (BCP)
A chronic inflammatory process leads to a decrease in the oxygenation of prostate tissues, which not only changes the parameters of the ejaculate, but also causes damage to the structure of the cell wall and the DNA of prostate epithelial cells. This may be the reason for the activation of neoplastic processes in the pancreas.
Material and research methods
The study included 94 patients with microbiologically verified CKD (NIH category II) aged 21 to 66 years. All patients underwent a comprehensive urological examination, which included filling out the CP symptom scale (NIH-CPSI), complete blood count (CBC), microbiological and immunohistochemical examination of pancreatic secretion, PCR diagnostics to exclude atypical intracellular flora, TRUS of the prostate, and uroflowmetry. The patients were divided into two equal groups of 47 people, in the 1st group there were 39 people (83%) aged 21-50 years, in the 2nd group - 41 (87%). Group 1 received ciprofloxacin 500 mg 2 times a day as part of complex treatment. after meals, the total duration of therapy was 3-4 weeks. The second group received levofloxacin (Eleflox) 500 mg 1 time / day, the duration of the course of treatment averaged 3-4 weeks. At the same time, patients were prescribed anti-inflammatory therapy (suppositories with indomethacin 50 mg 2 times / day for 1 week), α-blockers (tamsulosin 0.4 mg 1 time / day) and physiotherapy (magnetic laser therapy according to guidelines). Clinical control was carried out during the entire period of treatment of patients. Laboratory (bacteriological) quality control of treatment was carried out after 4-5 weeks. after taking the drug.
results
Clinical assessment of treatment results was carried out on the basis of complaints, objective examination and ultrasound data. In both groups, the majority of patients after 5-7 days from the start of treatment showed signs of improvement. Further therapy with levofloxacin (Eleflox) and ciprofloxacin showed the effectiveness of treatment in both groups.
In patients of the 1st group, a significant decrease and disappearance of symptoms were noted, as well as the normalization of the number of leukocytes in the secret of the pancreas, an increase in the maximum volumetric flow rate of urine according to uroflowmetry (from 15.4 to 17.2 ml/s). The average score on the NIH-CPSI scale decreased from 41.5 to 22. The prescribed therapy was well tolerated by patients. 3 patients (6.4%) developed side effects from the gastrointestinal tract (nausea, upset stool) associated with taking the antibiotic.
In patients of the 2nd group who received ciprofloxacin, there was a decrease or complete disappearance of complaints. The maximum volumetric flow rate of urine according to uroflowmetry increased from 16.1 to 17.3 ml/s. The mean NIH-CPSI score dropped from 38.5 to 17.2. Side effects were noted in 3 (6.4%) cases. Thus, we did not obtain significant differences based on clinical observation of both groups.
During the control bacteriological examination of the 1st group of 47 patients treated with levofloxacin, eradication of pathogens was achieved in 43 (91.5%).
During treatment with ciprofloxacin, the disappearance of the bacterial flora in the prostate secretion was observed in 38 (80%) patients.
Conclusion
To date, fluoroquinolones II and III generations, related to broad-spectrum antibacterial drugs, continue to be effective antimicrobial agents for the treatment of urological infections.
The results of clinical studies did not reveal a significant difference between the use of levofloxacin and ciprofloxacin. Good tolerability of drugs allows them to be used for 3-4 weeks. However, data from bacteriological studies showed the greatest antimicrobial efficacy of levofloxacin compared to ciprofloxacin. In addition, the daily dosage of levofloxacin is provided by a single dose of the tablet form of the drug, while patients must take ciprofloxacin twice a day.

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