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Brehm TJ, Trautner BW, Kulkarni PA. Acute and Chronic Infectious Prostatitis in Older Adults. Infect Dis Clin North Am 2023; 37:175-194. [PMID: 36805012 DOI: 10.1016/j.idc.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Acute and chronic bacterial prostatitis are clinically significant entities that can be difficult to diagnose and appropriately treat. Herein, we review when to suspect these clinical conditions, how to diagnose them, and how to effectively treat them based on the extant literature. Our aim was to equip the practicing clinician with the ability to proficiently diagnose and manage acute and chronic bacterial prostatitis, particularly in older patients.
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Affiliation(s)
- Tyler J Brehm
- Department of Medicine, Section of General Internal Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Barbara W Trautner
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX 77030, USA
| | - Prathit A Kulkarni
- Medical Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA; Department of Medicine, Infectious Diseases Section, Baylor College of Medicine, Houston, TX 77030, USA.
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Lupo F, Rousseau M, Canton T, Ingersoll MA. The Immune System Fails to Mount a Protective Response to Gram-Positive or Gram-Negative Bacterial Prostatitis. THE JOURNAL OF IMMUNOLOGY 2020; 205:2763-2777. [PMID: 33055280 DOI: 10.4049/jimmunol.2000587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/12/2020] [Indexed: 11/19/2022]
Abstract
Bacterial prostatitis affects 1% of men, with increased incidence in the elderly. Acute bacterial prostatitis frequently progresses to chronicity, marked by recurrent episodes interspersed with asymptomatic periods of variable duration. Antibiotic treatment is standard of care; however, dissemination of antimicrobially resistant uropathogens threatens therapy efficacy. Thus, development of nonantibiotic-based approaches to treat chronic disease is a priority. Currently, why chronic prostatitis arises is unclear, as the immune response to prostate infection is incompletely understood. As 80% of prostatitis cases are caused by Gram-negative uropathogenic Escherichia coli (UPEC) or Gram-positive Enterococcus faecalis, we used a mouse transurethral instillation model to address the hypothesis that an innate immune response fails to develop following prostate infection with these uropathogens, leading to chronic disease. Surprisingly, infection induced robust proinflammatory cytokine expression and myeloid cell infiltration. Following a second infection, cytokine responses and innate cell infiltration were largely comparable to primary infection. Characteristic of memory responses, more lymphoid cells infiltrated the prostate in a second infection compared with a first, suggesting that adaptive immunity develops to eliminate the pathogens. Unexpectedly, bacterial burden in prostates challenged with either UPEC or E. faecalis was equal or greater than primary infection despite that a protective adaptive response to UPEC infection was evident in the bladder of the same animals. Our findings support that chronic or recurrent prostatitis develops despite strong innate immune responses and may be the result of a failure to develop immune memory to infection, pointing to actionable targets for immunotherapy.
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Affiliation(s)
- Federico Lupo
- Department of Immunology, Institut Pasteur, 75015 Paris, France; and INSERM U1223, 75015 Paris, France
| | - Matthieu Rousseau
- Department of Immunology, Institut Pasteur, 75015 Paris, France; and INSERM U1223, 75015 Paris, France
| | - Tracy Canton
- Department of Immunology, Institut Pasteur, 75015 Paris, France; and INSERM U1223, 75015 Paris, France
| | - Molly A Ingersoll
- Department of Immunology, Institut Pasteur, 75015 Paris, France; and INSERM U1223, 75015 Paris, France
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Karaiskos I, Galani L, Sakka V, Gkoufa A, Sopilidis O, Chalikopoulos D, Alivizatos G, Giamarellou E. Oral fosfomycin for the treatment of chronic bacterial prostatitis. J Antimicrob Chemother 2020; 74:1430-1437. [PMID: 30796442 PMCID: PMC6477975 DOI: 10.1093/jac/dkz015] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 01/08/2023] Open
Abstract
Background Chronic bacterial prostatitis (CBP) is a difficult-to-treat infection as only a few antibiotics achieve therapeutic concentrations in the prostate. Data on the efficacy and safety of oral fosfomycin for the treatment of CBP are limited. Objectives To analyse the efficacy and safety of fosfomycin in CBP due to MDR pathogens. Methods In a prospective observational study, an oral regimen of 3 g of fosfomycin q24h for 1 week followed by 3 g q48h for a treatment duration of 6–12 weeks was administered. The outcome was clinical and microbiological cure rate at the end of treatment (EOT) and rate of relapse at 3 and 6 months. Results The study included 44 patients. The most common pathogen was Escherichia coli (66%), followed by Klebsiella spp. (14%) and Enterococcus faecalis (14%). Most strains were MDR (59%) and 23% had an ESBL phenotype; 33 of 44 strains were resistant to fluoroquinolones, but all were susceptible to fosfomycin (median MIC for Gram-negative pathogens 1.5 mg/L). In 25 patients, treatment was administered for 6 weeks, whereas in the remaining 19 patients it was prolonged to 12 weeks based on the presence of calcifications in the prostate. Cure rate was 82% at EOT and 80% and 73% at 3 and 6 months accordingly. Microbiological eradication was achieved in 86% and 77% at EOT and at 6 months, respectively. Failure was observed in 12 patients. The most common adverse event was diarrhoea (18%). Conclusions Oral fosfomycin, particularly in the era of MDR prevalence, represents an attractive, safe and effective alternative to fluoroquinolones for the treatment of CBP.
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Affiliation(s)
- Ilias Karaiskos
- 1st Department of Internal Medicine & Infectious Diseases, Hygeia General Hospital, Athens, Greece
| | - Lambrini Galani
- 1st Department of Internal Medicine & Infectious Diseases, Hygeia General Hospital, Athens, Greece
| | - Vissaria Sakka
- 3rd Department of Internal Medicine, Red Cross General Hospital, Athens, Greece
| | - Aikaterini Gkoufa
- 1st Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | | | | | - Eleni Giamarellou
- 1st Department of Internal Medicine & Infectious Diseases, Hygeia General Hospital, Athens, Greece
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Kwan ACF, Beahm NP. Fosfomycin for bacterial prostatitis: a review. Int J Antimicrob Agents 2020; 56:106106. [PMID: 32721595 DOI: 10.1016/j.ijantimicag.2020.106106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/17/2020] [Accepted: 07/19/2020] [Indexed: 11/25/2022]
Abstract
There has been growing interest in fosfomycin for the treatment of bacterial prostatitis due to evidence suggesting that it achieves adequate prostatic concentrations for antimicrobial effect, has activity against resistant micro-organisms, and has a low-toxicity profile. This review evaluated the current clinical evidence for fosfomycin in acute and chronic bacterial prostatitis to elucidate the clinical implications of fosfomycin in an era of increasing antimicrobial resistance. PubMed, Scopus, EMBASE, Web of Science, Google Scholar and ClinicalTrials.gov were searched for studies published in the English language from January 1984 to November 2019. The inclusion criteria were met if the study reported the use of fosfomycin (more than one dose) to treat bacterial prostatitis. Ten observational studies were identified that met the inclusion criteria. The evidence for the use of fosfomycin in acute bacterial prostatitis is sparse. The majority of the available evidence is for chronic bacterial prostatitis caused by Escherichia coli. Despite the implementation of variable dosing regimens, extended courses of fosfomycin appear to be safe and effective in achieving clinical and microbiological cure. In these studies, the use of fosfomycin was restricted to cases of treatment failure, intolerance to first-line therapy, or multi-resistant organisms. However, given the development of resistant organisms and the undesirable adverse effects of many first-line therapeutic options, fosfomycin has the potential to be considered as an effective first-line alternative for acute and chronic bacterial prostatitis in the future. Further studies, including randomized controlled trials, would be helpful to firmly establish its optimal dosing regimen, efficacy and place in therapy.
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Affiliation(s)
- Alex C F Kwan
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada T6G 1C9
| | - Nathan P Beahm
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada T6G 1C9.
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Xiong S, Liu X, Deng W, Zhou Z, Li Y, Tu Y, Chen L, Wang G, Fu B. Pharmacological Interventions for Bacterial Prostatitis. Front Pharmacol 2020; 11:504. [PMID: 32425775 PMCID: PMC7203426 DOI: 10.3389/fphar.2020.00504] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/31/2020] [Indexed: 12/16/2022] Open
Abstract
Prostatitis is a common urinary tract condition but bring innumerable trouble to clinicians in treatment, as well as great financial burden to patients and the society. Bacterial prostatitis (acute bacterial prostatitis plus chronic bacterial prostatitis) accounting for approximately 20% among all prostatitis have made the urological clinics complain about the genital and urinary systems all over the world. The international challenges of antibacterial treatment (emergence of multidrug-resistant bacteria, extended-spectrum beta-lactamase-producing bacteria, bacterial biofilms production and the shift in bacterial etiology) and the transformation of therapeutic strategy for classic therapy have attracted worldwide attention. To the best of our knowledge currently, there is not a single comprehensive review, which can completely elaborate these important topics and the corresponding treatment strategy in an effective way. This review summarizes the general treatment choices for bacterial prostatitis also provides the alternative pharmacological therapies for those patients resistant or intolerant to general treatment.
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Affiliation(s)
- Situ Xiong
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaoqiang Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Wen Deng
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Zhengtao Zhou
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Yulei Li
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Yechao Tu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Luyao Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Gongxian Wang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Bin Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
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Moustakas I, Dryllis G, Pouliakis A, Petrikos G, Daikos G, Pittaras T, Karasante P, Karampotsis K, Tsiodras S. Emerging patterns of resistance in a cohort of Greek patients with recurrent UTIs: a pilot study. J Chemother 2019; 31:367-377. [PMID: 31409214 DOI: 10.1080/1120009x.2019.1652013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Bacterial urogenital infections caused by multi-drug resistant organisms (MDROs), are increasingly becoming a severe public health issue. The purpose of the present study was to examine the epidemiology of recurrent UTIs along with antimicrobial resistance patterns in a cohort of patients followed as outpatients at an Infectious Disease clinic of a tertiary care center in Greece. One hundred, sequential patients suffering from recurrent UTIs and coming for clinical evaluation, follow-up and treatment were examined; microbiological urine culture results were analyzed. Patients were separated into Group A: patients with ≥3 urogenital infections during the last study year, and Group B: patients with ≤2 urogenital infections. Furthermore, antimicrobial resistance patterns and presence of MDROs in relation to the number of urogenital infections during a three years period was evaluated. Group A had a mean of 4.3 ± 1.7 urogenital infections during the last year of the study, while patients in Group B 1.9 ± 0.3 infections over a three years period. An age cut-off of 30 years was critical for higher UTI rates. Escherichia Coli was the predominant isolated pathogen in 96.2% of the patients. Patients with diabetes mellitus had a 3 fold-higher risk for ≥3 UTIs. Resistance to colistin and imipenem was associated with a history of more than 2 episodes of UTIs but observed in a small number of patients with comorbidities. In this pilot study MDRO detection in patients suffering from recurrent UTIs emphasizes the need for continuous epidemiological surveillance in order to improve our understanding of the evolution of resistance in a common community infection as well as to implement successful prevention strategies.
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Affiliation(s)
- Ioannis Moustakas
- Department of Microbiology, "Aretaieion" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Dryllis
- Department of First Internal Medicine Clinic, "Laikon" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Avraham Pouliakis
- Second Department of Pathology, University General Hospital "ATTIKON", School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Georgios Daikos
- Department of First Internal Medicine Clinic, "Laikon" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Pittaras
- Department of Microbiology, "Aretaieion" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Sotirios Tsiodras
- Fourth Department of Internal Medicine, Division of Hematology, "ATTIKO" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Magri V, Perletti G, Cai T, Stamatiou K, Trinchieri A, Montanari E. Levofloxacin for NIH Category II Chronic Bacterial Prostatitis: A Real-Life Study. Chemotherapy 2019; 64:8-16. [PMID: 31112957 DOI: 10.1159/000499034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/14/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mounting worldwide resistance trends make the use of fluoroquinolone (FQ) antibacterial agents increasingly difficult. This is felt more acutely in the case of urogenital infections, which are mainly caused by Gram-negative pathogens. For years, levofloxacin and other FQs have been the first-line drugs for treating National Institutes of Health (NIH) category II chronic bacteria prostatitis (CBP). Eradication rates achieved by levofloxacin in the frame of randomized trials vary greatly, ranging between 71 and 86%. OBJECTIVES This was a retrospective observational study to investigate the efficacy of levofloxacin against CBP in a real-life setting (urological outpatient wards). METHODS A database including the clinical records of >2,500 CBP patients was reviewed. Patients were selected based on strict inclusion criteria. They were treated for 4 weeks with 500 mg levofloxacin per day, alone or combined with other antibacterials. Besides standard urological procedures including the 4-glass test for pathogen isolation, international symptom questionnaires (the NIH Chronic Prostatitis Symptom Index [NIH-CPSI] and International Prostate Symptom Score [IPSS]) were administered. RESULTS Pathogen eradication was achieved in 79% of the cases treated with levofloxacin as a single agent and 87.8% of patients who received a combination of levofloxacin and azithromycin. The 11% increase in the eradication rate in the latter group is statistically significant. In addition, the levofloxacin-azithromycin combination caused a significant decrease in prostate volume and significantly increased the bladder-voided volume. IPSS and NIH-CPSI values and the urinary peak flow rate decreased to a similar extent in both treatment groups. No adverse effects were reported by patients belonging to either treatment group. CONCLUSION Levofloxacin retained its therapeutic efficacy in patients assessed in a real-life setting, and high eradication rates were attained when it was administered as a single agent. A combination of an FQ with azithromycin induced a significant improvement of eradication rates. This strategy may be an interesting option in both first-referral and relapsing cases, although caution should be exercised when patients are at risk of developing arrhythmias, tendinitis, or other adverse effects.
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Affiliation(s)
| | - Gianpaolo Perletti
- Department of Biotechnology and Life Sciences, Section of Medical and Surgical Sciences, Università degli Studi dell'Insubria, Varese, Italy, .,Faculty of Medicine and Medical Sciences, Ghent University, Ghent, Belgium,
| | - Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, Trento, Italy
| | | | | | - Emanuele Montanari
- Department of Urology, University of Milan-Ca' Granda Foundation, Ospedale Maggiore Policlinico, Milan, Italy
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Murphy SF, Anker JF, Mazur DJ, Hall C, Schaeffer AJ, Thumbikat P. Role of gram-positive bacteria in chronic pelvic pain syndrome (CPPS). Prostate 2019; 79:160-167. [PMID: 30242864 PMCID: PMC6623965 DOI: 10.1002/pros.23721] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/05/2018] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Chronic pelvic pain syndrome (CPPS) is a complex disorder that affects a large proportion of all men. A limited understanding of its etiology and pathogenesis is reflected by the absence of effective therapies. Although CPPS is deemed clinically non-infectious with no well-defined etiological role for microbes, bacteria is readily isolated from both healthy and patient prostate secretion and urine samples. Our laboratory has previously demonstrated that a specific gram-negative bacterial isolate can induce CPPS-like symptoms in mice. Here we aimed to expand on these findings examining the role of gram-positive patient-derived bacteria in CPPS. METHODS A retrospective analysis of bacterial cultures from CPPS patients from a single center was performed. Gram-positive bacteria were isolated from the expressed prostatic secretion (EPS) of three CPPS-patients (pain inducers, PI) and one from a healthy volunteer (non-pain inducer, NPI). These bacteria were inoculated intra-urethrally in two mouse backgrounds and analyzed for their ability to induce tactile allodynia, voiding dysfunction, and colonize the murine prostate. Host immune responses to bacterial instillation were analyzed by flow cytometry. RESULTS PI strains (Staphylococcus haemolyticus 2551, Enterococcus faecalis 427, and Staphylococcus epidermidis 7244) induced and maintained tactile allodynia responses (200% increase above baseline) for 28 days in NOD/ShiLtJ mice. Conversely the healthy subject derived strain (Staphylococcus epidermidis NPI) demonstrated no significant pelvic allodynia induction. Intra-urethral inoculation of the four bacterial strains into C57BL/6 mice did not induce significant increases in pain responses. Infected NOD/ShiLtJ displayed significant voiding dysfunction compared to their control counterparts. Colony counts of prostate tissues from both NOD/ShiLtJ and C57BL/6 mice at day 28 demonstrated that bacterial strains colonized equally well, including NPI. We also determined that mechanistically, the patient-isolates induced prostate inflammation specifically involving T-cells and monocytes. CONCLUSIONS Gram-positive isolates from CPPS patients showed enhanced ability to induce tactile allodynia compared to a single taxonomically similar gram-positive strain isolated from a healthy control. Responses were shown to be dependent on host genetic background and not on colonization differences between strains.
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Affiliation(s)
- Stephen F. Murphy
- Dept. of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Jonathan F. Anker
- Dept. of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Daniel J. Mazur
- Dept. of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Christel Hall
- Dept. of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Anthony J. Schaeffer
- Dept. of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Praveen Thumbikat
- Dept. of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Seo Y, Lee G. New Bacterial Infection in the Prostate after Transrectal Prostate Biopsy. J Korean Med Sci 2018; 33:e126. [PMID: 29686597 PMCID: PMC5909103 DOI: 10.3346/jkms.2018.33.e126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 02/27/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The prostate is prone to infections. Hypothetically, bacteria can be inoculated into the prostate during a transrectal prostate biopsy (TRPB) and progress into chronic bacterial prostatitis. Therefore, we examined new bacterial infections in biopsied prostates after TRPB and whether they affect clinical characteristics in the biopsied patients. METHODS Of men whose prostate cultures have been taken prior to TRPB, 105 men with bacteria-free benign prostate pathology underwent an additional repeated prostate culture within a year after TRPB. RESULTS Twenty out of 105 men (19.05%) acquired new bacteria in their naïve prostates after TRPB. Except for one single case of Escherichia coli infection, 19 men had acquired gram-positive bacteria species. Between the culture-positive and negative groups, there were no significant differences in age, serum prostate-specific antigen (PSA) level, white blood cell (WBC) counts in expressed prostatic secretion (EPS), prostate volume, symptom severities in Korean version of the National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) questionnaire, and patient-specific risk factors for biopsy associated infectious complications. Additionally, the TRPB procedure increased the WBC counts in post-biopsy EPS (P = 0.031, McNemar test), but did not increase the serum PSA level and symptoms of NIH-CPSI in 20 men who acquired new bacteria after TRPB. CONCLUSION The TRPB procedure was significantly associated with acquiring new bacterial infections in the biopsied prostate, but these localized bacteria did not affect patients' serum PSA level and symptoms after biopsy.
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Affiliation(s)
- Yumi Seo
- Department of Urology, Dankook University College of Medicine, Cheonan, Korea
| | - Gilho Lee
- Department of Urology, Dankook University College of Medicine, Cheonan, Korea
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Povidone-iodine rectal cleansing and targeted antimicrobial prophylaxis using rectal swab cultures in men undergoing transrectal ultrasound-guided prostate biopsy are associated with reduced incidence of postoperative infectious complications. Int Urol Nephrol 2016; 48:1763-1770. [DOI: 10.1007/s11255-016-1394-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
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Long-Term Fosfomycin-Tromethamine Oral Therapy for Difficult-To-Treat Chronic Bacterial Prostatitis. Antimicrob Agents Chemother 2015; 60:1854-8. [PMID: 26666924 DOI: 10.1128/aac.02611-15] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 12/02/2015] [Indexed: 11/20/2022] Open
Abstract
This is a retrospective study of 15 difficult-to-treat (i.e., exhibiting previous failure, patient side effects, or resistance to ciprofloxacin and co-trimoxazole) chronic bacterial prostatitis infections (5 patients with multidrug-resistant Enterobacteriaceae [MDRE]) receiving fosfomycin-tromethamine at a dose of 3 g per 48 to 72 h for 6 weeks. After a median follow-up of 20 months, 7 patients (47%) had a clinical response, and 8 patients (53%) had persistent microbiological eradication; 4/5 patients with MDRE isolates achieved eradication. There were no side effects. Fosfomycin-tromethamine is a possible alternative therapy for chronic bacterial prostatitis.
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Wagenlehner F. Re: Comparative Effectiveness of Targeted vs Empirical Antibiotic Prophylaxis to Prevent Sepsis from Transrectal Prostate Biopsy: A Retrospective Analysis: M. A. Liss, W. Kim, D. Moskowitz and R. J. Szabo J Urol 2015;194:397-402. J Urol 2015; 195:224-5. [PMID: 26432938 DOI: 10.1016/j.juro.2015.07.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Florian Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University, Giessen, Germany.
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El Meliegy AI, Torky M. An observational study to monitor the efficacy and tolerability of levofloxacin 500 mg once daily for treatment of chronic bacterial prostatitis in Saudi Arabia. Urol Ann 2015; 7:71-3. [PMID: 25657549 PMCID: PMC4310122 DOI: 10.4103/0974-7796.148623] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 02/10/2014] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Chronic prostatitis is a common urological problem in men <50-year-old. Untypical uropathogens and an intact blood prostate barrier cause difficulty in using antibiotics to treat the infection. PATIENTS AND METHODS In this open-label, observational study, levofloxacin 500 mg was given once daily for 28 days for treatment of chronic prostatitis. The primary efficacy measurement was the disappearance of all pre-treatment symptoms. Efficacy analysis is based on the per protocol population (PPP), all other analyses use the intent to treat (ITT) population. RESULTS The ITT included 154 men and the PPP included 151 (results are for the ITT unless otherwise indicated). Mean age was 42 ± 9 years, common concomitant conditions were diabetes mellitus (7%) and hypertension (5%). All symptoms decreased at day 28. Notably, the rate of dysuria decreased from 86.1% to 10.6%, painful ejaculation from 71% to 2.6% and perineal discomfort from 60.3% to 7.3%. A cure of condition was identified in 58.9%. No treatment failures were reported. Physician-reported adherence to study medication was 96.8%. CONCLUSION Levofloxacin appears to be an effective antibiotic for treating symptoms of chronic bacterial prostatitis. Levofloxacin was well-tolerated in this population.
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Affiliation(s)
- Amr Ismail El Meliegy
- Department of Andrology, Dr. Soliman Fakeeh Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Mohammed Torky
- Department of Urology, Erfan Hospital, Jeddah, Kingdom of Saudi Arabia
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Abstract
Over the years, prostate biopsy has become the gold-standard technique for diagnosing prostate carcinoma. Worldwide, several million prostate biopsies are performed every year, most commonly using the transrectal approach. Preoperative antibiotic prophylaxis with fluoroquinolones has been shown to be effective for reducing infection rates. However, in recent years, an increase in febrile infection rates after transrectal prostate biopsy (from 1% to 4%) has been reported in retrospective and prospective studies. The predominant risk factor for infection seems to be the presence of fluoroquinolone-resistant bacteria in faeces. Patients at risk of fluoroquinolone resistance should receive carefully selected antibiotics at sufficient concentrations to be effective. Targeted prophylaxis after rectal flora swabbing has been shown to be efficacious compared with empirical antibiotic prophylaxis. Several forms of bowel preparations are under investigation, although none have yet been shown to significantly reduce infection rates. Perineal prostate biopsy is currently being evaluated as a strategy for preventing the inoculation of rectal flora, but limited data support this approach at present.
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Škerk V, Roglić S, Čajić V, Markotić A, Radonić A, Škerk V, Granić J, Žcidovec-Lepej S, Parazajder J, Begovac J. Comparison of Clinical Symptoms Scored According to the National Institutes of Health Chronic Prostatitis Symptoms Index and Assessment of Antimicrobial Treatment in Patients with Chronic Prostatitis Syndrome. J Chemother 2013; 21:181-7. [DOI: 10.1179/joc.2009.21.2.181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Sawma-Aouad G, Hashwa F, Tokajian S. Antimicrobial Resistance in Relation to Virulence Determinants and Phylogenetic Background Among UropathogenicEscherichia coliin Lebanon. J Chemother 2013; 21:153-8. [DOI: 10.1179/joc.2009.21.2.153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Safety and efficacy of levofloxacin versus ciprofloxacin for the treatment of chronic bacterial prostatitis in Chinese patients. Asian J Androl 2012; 14:870-4. [PMID: 22864282 DOI: 10.1038/aja.2012.48] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Levofloxacin is a synthetic fluoroquinolone that is usually used to treat chronic bacterial prostatitis. We investigated the safety and efficacy of levofloxacin compared with ciprofloxacin for the treatment of chronic bacterial prostatitis in Chinese patients. This was a multicenter, open-label, randomized controlled non-inferiority trial. Four hundred and seventy-one patients with clinical symptoms/signs were enrolled into the study, and 408 patients were microbiologically confirmed chronic bacterial prostatitis, who were randomized to either oral levofloxacin (500 mg q.d.) or ciprofloxacin (500 mg b.i.d.) for 4 weeks. Bacterial clearance rate, clinical symptoms/signs, adverse reactions and disease recurrence were assessed. The clinical symptoms and signs (including dysuria, perineal discomfort or pain) and bacteria cultures in 209 patients treated with levofloxacin and 199 patients treated with ciprofloxacin were similar. The most common bacteria were Escherichia coli and Staphylococcus aureus. One to four weeks after the end of 4 weeks treatment, the bacterial clearance rate (86.06% vs. 60.03%; P<0.05) and the clinical efficacy (including clinical cure and clinical improvement(93.30% vs. 71.86%; P<0.05)) were significantly higher in the levofloxacin-treated group than in the ciprofloxacin-treated group. The microbiological recurrence rate was significantly lower in the levofloxacin-treated group than in the ciprofloxacin-treated group (4.00% vs. 19.25%; P<0.05). Rates of adverse events and treatment-related adverse events were slightly lower in the levofloxacin-treated group than in ciprofloxacin-treated group. Levofloxacin showed some advantages over ciprofloxacin in terms of clinical efficacy and disease recurrence, with a low rate of adverse events, for the treatment of chronic bacterial prostatitis in Chinese patients.
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Schiller DS, Parikh A. Identification, pharmacologic considerations, and management of prostatitis. ACTA ACUST UNITED AC 2012; 9:37-48. [PMID: 21459307 DOI: 10.1016/j.amjopharm.2011.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2011] [Indexed: 02/03/2023]
Abstract
BACKGROUND Prostatitis is a collection of signs and symptoms that occur as a result of inflammation or swelling of the prostate gland. There are many different causes for prostatitis, including infection; occasionally no clear etiology for the inflammation is found. Effective treatment often depends on identification of the cause, but a microbiologic organism is not always detectable, especially in cases of chronic prostatitis. OBJECTIVE The aim of this article was to review identification and treatment options for prostatitis, including pharmacologic and nonpharmacologic interventions. METHODS Relevant information was identified through a search of MEDLINE (1966-June 2010), International Pharmaceutical Abstracts (1970-June 2010), and EMBASE (1947-June 2010). Randomized, controlled trials that examined prostate cancer, benign prostatic hypertrophy, or procedures related to the prostate (ie, biopsies) were excluded. RESULTS A working classification system for prostatitis was developed in 1999, but there are few randomized controlled trials that distinguish between the various treatment options. Bacterial prostatitis can be acute or chronic but always requires some degree of antimicrobial therapy. Pharmacologic features of fluoroquinolones make them the preferred agents for most patients. These antibiotics can become trapped in a chronically inflamed prostate due to pH differences between prostatic tissue and serum. Many fluoroquinolones have penetration ratios (prostate level:serum level) of up to 4:1. A study in European men (N = 117) who received levofloxacin 500 mg/d with a diagnosis of chronic bacterial prostatitis demonstrated clinical success rates of 92% (95% CI 84.8%-96.5%), 77.4% (95% CI, 68.2-84.9%), 66.0% (95% CI, 56.2%-75.0%), and 61.9% (95% CI, 51.9%-71.2%) at 5-12 days, 1 month, 3 months, and 6 months after treatment. Additionally, there have been numerous randomized, placebo-controlled trials in patients with chronic prostatitis that have studied α-blockers, steroid inhibitors, anti-inflammatory agents, and bioflavonoids. Treatment responses to α-blockers appear to be greater with longer durations of therapy in α-blocker-naïve patients (National Institutes of Health-Chronic Prostatitis Symptom Index [NIH-CPSI] score reduction of at least 3.6 points after 6 weeks of tamsulosin therapy [P = 0.04] and up to 14.3 and 9.9 point NIH-CPSI score reductions with 14 weeks of terazosin and 24 weeks of alfuzosin therapy, respectively [P = 0.01 for both]). Combination therapy with an α-blocker, an anti-inflammatory, and a muscle relaxant does not appear to offer significant advantages over monotherapy (12.7 vs 12.4 point reduction in NIH-CPSI scores) and a stepwise approach to therapy involving antibiotics followed by bioflavonoids and then α-blockers appears to effectively reduce symptoms for up to 1 year in patients with chronic prostatitis (mean NIH-CPSI point reduction of 9.5 points compared with baseline, P < 0.0001). Patients who have had multiple unsuccessful treatment regimens may benefit from direct stimulation of the pelvic muscles through electromagnetic or electroacupuncture therapy. CONCLUSIONS Prostatitis can resemble various other medical conditions but proper classification and an understanding of the pharmacologic features and expectations of the medications used to treat it can help identify effective treatment strategies. Fluoroquinolones are the preferred agents for treating bacterial causes of prostatitis and have demonstrated efficacy in some cases of chronic prostatitis when an organism has not been identified. However, the use of agents with anti-inflammatory or antiadrenergic properties may be necessary in combination with or after trying antimicrobial agents.
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Affiliation(s)
- Daryl S Schiller
- Department of Pharmacy, Saint Barnabas Medical Center, Livingston, New Jersey 07039, USA.
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Wu J, Yuan Q, Zhang D, Zhang X, Zhao L, Zhang X, Ruan J. Evaluation of Chinese medicine Qian-Yu for chronic bacterial prostatitis in rats. Indian J Pharmacol 2011; 43:532-5. [PMID: 22021995 PMCID: PMC3195122 DOI: 10.4103/0253-7613.84964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 02/16/2011] [Accepted: 07/01/2011] [Indexed: 11/16/2022] Open
Abstract
Objectives: Qian-Yu (QY), a Chinese medicine formula, has anti-inflammatory and broad spectrum anti-bacterial activity. This study is undertaken to evaluate the anti-inflammatory effects of Qian-Yu (QY) in chronic bacterial prostatitis (CBP). Materials and Methods: The potential of QY in the treatment of CBP was evaluated using a CBP animal model by examining the anti-inflammatory activity. Its consequences were analyzed by immunological and histopathological methods. Experimental chronic bacterial prostatitis was induced by instillation of bacterial suspension of Escherichia coli 7.5 × 105 CFU/ml into the prostatic urethra. Animals were followed up for four weeks and then treated with either 7 mg/kg QY or 7 mg/kg positive control agent-Qianlietai (QLT) or 1 ml of phosphate-buffered saline (PBS) for the controls. Ten rats in each group were sacrificed at the end of four weeks. The inhibition of inflammation and its consequences were analyzed histologically. Prostatic IL-8, SIgA and zinc concentrations were measured by ELISA, RIA and ICP-AES, respectively. The data was expressed as mean ± S.D. Least-significant difference (LSD) of one-way ANOVA (SPSS 12.0) was used to determine the differences of scores. Results: The histopathology showed resolving prostatitis in QY-and QLT-treated groups and the immunology showed reduction of IL-8 and increment of SIgA contents in prostatic tissues as compared to the control groups. The prostatic zinc levels were higher in the QY-and QLT-treated groups than those in the controls. These results suggested that QY is effective in CBP treatment.
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Affiliation(s)
- Jinhu Wu
- Department of Pharmacology, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
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Prulifloxacin: a review focusing on its use beyond respiratory and urinary tract infections. Int J Antimicrob Agents 2011; 37:283-90. [DOI: 10.1016/j.ijantimicag.2010.11.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 11/19/2010] [Indexed: 11/22/2022]
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Bulitta JB, Kinzig M, Naber CK, Wagenlehner FM, Sauber C, Landersdorfer CB, Sörgel F, Naber KG. Population Pharmacokinetics and Penetration into Prostatic, Seminal, and Vaginal Fluid for Ciprofloxacin, Levofloxacin, and Their Combination. Chemotherapy 2011; 57:402-16. [DOI: 10.1159/000329520] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 02/22/2011] [Indexed: 01/26/2023]
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Delavierre D, Rigaud J, Sibert L, Labat JJ. [Specific treatments for chronic bacterial prostatitis and chronic pelvic pain syndrome]. Prog Urol 2010; 20:1066-71. [PMID: 21056386 DOI: 10.1016/j.purol.2010.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 09/21/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To review the treatment of chronic bacterial prostatitis and chronic pelvic pain syndrome (CPPS). MATERIAL AND METHODS A review of the literature was performed by searching the Medline database (National Library of Medicine). Search terms were either Medical subject heading (MeSH) keywords (antibacterial agents, pelvic pain, placebos, prostatitis, treatment) or terms derived from the title or abstract. Search terms were used alone or in combinations by using the "AND" operator. The literature search was conducted from 1990 to the present time. RESULTS The treatment of chronic bacterial prostatitis is based on the use of antibiotics, primarily fluoroquinolones, for 4 to 6 weeks, but no consensus has been reached concerning the standard treatment of CP/CPPS. A review of the literature failed to identify any recognized and validated treatments for CP/CPPS, but several conclusions can be drawn: placebo gives satisfactory results in a considerable number of patients; antibiotics are not recommended; alpha-blocking agents may be effective in recently diagnosed, previously untreated patients, provided they are prescribed for 12 weeks to 6 months; invasive surgery of the prostate and bladder neck is not recommended. CONCLUSION Progress in the treatment of CP/CPPS will require more extensive basic and clinical research. Only randomized, placebo-controlled clinical trials including a large number of patients, and using the NIH-Chronic Prostatitis Symptom Index questionnaire (NIH-CPSI) as evaluation tool will be able to provide reliable conclusions. The use of patient subgroups selected according to the predominant symptoms could be contributive.
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Affiliation(s)
- D Delavierre
- Service d'urologie-andrologie, CHR La-Source, 14, avenue de l'Hôpital, 45067 Orléans cedex 2, France.
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Risk factors for fluoroquinolone resistance in Enterococcus urinary tract infections in hospitalized patients. Epidemiol Infect 2010; 139:955-61. [PMID: 20696087 DOI: 10.1017/s095026881000186x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Past studies exploring risk factors for fluoroquinolone (FQ) resistance in urinary tract infections (UTIs) focused only on UTIs caused by Gram-negative pathogens. The epidemiology of FQ resistance in enterococcal UTIs has not been studied. We conducted a case-control study at two medical centres within the University of Pennsylvania Health System in order to identify risk factors for FQ resistance in enterococcal UTIs. Subjects with positive urine cultures for enterococci and meeting CDC criteria for healthcare-acquired UTI were eligible. Cases were subjects with FQ-resistant enterococcal UTI. Controls were subjects with FQ-susceptible enterococcal UTI and were frequency matched to cases by month of isolation. A total of 136 cases and 139 controls were included from 1 January 2003 to 31 March 2005. Independent risk factors [adjusted OR (95% CI)] for FQ resistance included cardiovascular diseases [2·24 (1·05-4·79), P=0·037], hospitalization within the past 2 weeks [2·08 (1·05-4·11), P=0·035], hospitalization on a medicine service [2·15 (1·08-4·30), P<0·030], recent exposure to β-lactamase inhibitors (BLIs) [14·98 (2·92-76·99), P<0·001], extended spectrum cephalosporins [9·82 (3·37-28·60), P<0·001], FQs [5·36 (2·20-13·05), P<0·001] and clindamycin [13·90 (1·21-10·49), P=0·035]. Use of BLIs, extended spectrum cephalosporins, FQs and clindamycin was associated with FQ resistance in enterococcal uropathogens. Efforts to curb FQ resistance should focus on optimizing use of these agents.
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Sohn DW, Han CH, Jung YS, Kim SI, Kim SW, Cho YH. Anti-inflammatory and antimicrobial effects of garlic and synergistic effect between garlic and ciprofloxacin in a chronic bacterial prostatitis rat model. Int J Antimicrob Agents 2009; 34:215-9. [DOI: 10.1016/j.ijantimicag.2009.02.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2008] [Revised: 02/04/2009] [Accepted: 02/05/2009] [Indexed: 10/20/2022]
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Abstract
Completing its initial phases of drug development in the mid 1990s as the one of the first fluoroquinolones that could be used with confidence to treat respiratory tract infections, levofloxacin went on to become one of the most widely prescribed antibiotics in the world. Available in both oral (po) and intravenous (IV) formulations and with characteristics of over 90% bioavailability, distribution into both extracellular and intracellular pulmonary compartments, highly predictable pharmacokinetics with over 90% of the drug being excreted unchanged in urine, and reliable activity against a broad spectrum of clinically important pathogens, levofloxacin has been used successfully to treat patients with a variety of serious infectious diseases as well as common infections most often treated outside of the hospital setting. Results of clinical trials involving patients with respiratory tract, urinary tract, and skin infections have consistently shown rates of clinical success and bacteriological eradication that were comparable to other widely used broad-spectrum agents. Regimens of levofloxacin, initially involving total daily doses of 250 mg to 500 mg, but more recently regimens involving 750 mg doses, have been shown to be safe and effective. Nearly a decade and a half of clinical experience has defined a safety and tolerability profile that permits data-driven assessment of the risks and benefits of using levofloxacin. As resistance to currently available fluoroquinolones has emerged, the clinical value of levofloxacin deserves continued evaluation. However, consistently high rates of susceptibility of clinically important bacteria, especially among those bacteria that commonly cause respiratory tract infections, such as Streptococcus pneumoniae and Haemophilus influenzae, suggest that this agent will continue to be a widely used well past the 20-year anniversary of its introduction into the antibacterial armamentarium.
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Affiliation(s)
- Gary J. Noel
- Johnson & Johnson Pharmaceutical Research and Development, LLC, Raritan, NJ, USA
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Wagenlehner FME, Naber KG, Bschleipfer T, Brähler E, Weidner W. Prostatitis and male pelvic pain syndrome: diagnosis and treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2009; 106:175-83. [PMID: 19568373 DOI: 10.3238/arztebl.2009.0175] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Accepted: 08/27/2008] [Indexed: 12/16/2022]
Abstract
BACKGROUND The prostatitis syndrome is a multifactorial condition of largely unknown etiology. The new NIH classification divides the prostatitis syndrome into a number of subtypes: acute bacterial prostatitis, chronic bacterial prostatitis, inflammatory and noninflammatory chronic pelvic pain syndrome, and asymptomatic prostatitis. METHODS This article is based on a selective review of the literature regarding the assessment and management of the prostatitis syndrome and on a recently published consensus statement of the International Prostatitis Collaboration Network. RESULTS Pathogenic organisms can be cultured only in acute and chronic bacterial prostatitis. These conditions should be treated with antibiotics, usually fluoroquinolones, for an adequate period of time. 90% of patients with prostatitis syndrome, however, suffer not from bacterial prostatitis but from chronic (abacterial) prostatitis / chronic pelvic pain syndrome (CP/CPPS). It remains unclear whether CP/CPPS is of infectious origin, and therefore the utility of a trial of antimicrobial treatment is debatable. Treatment with alpha receptor blockers is recommended if functional subvesical obstruction is documented or suspected. Symptomatic therapy for pelvic pain should be given as well. CONCLUSIONS The prostatitis syndrome is a complex condition with a tendency toward chronification. It is important, therefore, that the patient be fully informed about the diagnostic uncertainties and the possibility that treatment may meet with less than complete success.
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Affiliation(s)
- Florian M E Wagenlehner
- Klinik und Poliklinik für Urologie und Kinderurologie, Justus-Liebig-UniversitätGiessen, Giessen, Germany.
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Kim SI, Yim SH, Sohn DW, Lee SJ, Ha US, Han CH, Cho YH. Preventive Effect on Inflammation and Anti-Inflammatory and Anti-Microbial Effects of Garlic Extract in a Rat Model of Chronic Bacterial Prostatitis. Korean J Urol 2009. [DOI: 10.4111/kju.2009.50.6.602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Sung In Kim
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Seung Hyuk Yim
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Dong Wan Sohn
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Seung-Ju Lee
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - U-Syn Ha
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Chang Hee Han
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yong-Hyun Cho
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
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McGregor JC, Allen GP, Bearden DT. Levofloxacin in the treatment of complicated urinary tract infections and acute pyelonephritis. Ther Clin Risk Manag 2008; 4:843-53. [PMID: 19209267 PMCID: PMC2621400 DOI: 10.2147/tcrm.s3426] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Levofloxacin is a widely used fluoroquinolone approved for the treatment of complicated urinary tract infections and acute pyelonephritis. A comprehensive review of the medical literature identified five publications evaluating levofloxacin for the treatment of either complicated urinary tract infections or acute pyelonephritis. All trials, although variable in their inclusion criteria and levofloxacin dosing strategies, reported microbiologic, clinical, and safety-related outcomes. High microbiologic eradication rates, ranging from 79.8% to 95.3%, were observed in all studies. Escherichia coli was the most commonly isolated uropathogen. Data on levofloxacin resistance, both at baseline and after therapy, were limited. Clinical success was observed to range from 82.6% to 93% when measured after the completion of therapy. These clinical and microbiologic results were comparable to the fluoroquinolone comparators in all trials. Insufficient data are available to evaluate the outcomes in any meaningful patient subgroups, including catheterized patients, and those with other specific complicating factors. Levofloxacin was well tolerated in these studies, with headache, gastrointenstinal effects, and dizziness being the most commonly reported adverse events. The published data support the use of levofloxacin in complicated urinary tract infections and acute pyelonephritis. Further trials are necessary to evaluate levofloxacin within specific patient sub-populations.
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