trimethoprim--sulfamethoxazole-drug-combination and Prostatitis

Antimicrobial therapy is the standard of care for the unusual man with true chronic bacterial prostatitis but does not have much of a role in the treatment of men with nonbacterial prostatitis. The fluoroquinolone antibiotics given for 2 to 4 weeks will cure about 70% of chronic bacterial infections of the prostate. If this treatment fails, the symptomatic manifestations of the infections can almost always be eliminated with suppressive antimicrobial therapy using trimethoprim-sulfamethoxazole, a fluoroquinolone antibiotic, or nitrofurantoin.

Topics: Anti-Infective Agents; Bacterial Infections; Chronic Disease; Fluoroquinolones; Humans; Male; Nitrofurantoin; Prostatitis; Trimethoprim, Sulfamethoxazole Drug Combination; Urine

Urinary tract infections in boys and men are common causes of significant morbidity and, when coupled with urinary tract abnormalities, loss of renal function. Careful and prompt urological assessment is mandatory for proper treatment and prevention of serious and/or chronic sequelae.

Topics: 4-Quinolones; Anti-Infective Agents; Bacteriuria; Gram-Negative Bacteria; Humans; Male; Nitrofurantoin; Prostatitis; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Bacterial prostatitis can be distinguished from nonbacterial prostatitis on the basis of the symptoms, the findings on physical examination and the results of microbiologic testing. Evaluation of fractionated urine specimens, including expressed prostatic secretions, is helpful in making the diagnosis. Bacterial prostatitis may be acute or chronic. Acute prostatitis can be a serious illness requiring inpatient treatment with parenteral antibiotics. Chronic prostatitis is difficult to cure, and prolonged antibiotic therapy is required for eradication of symptoms. The most useful agents for the treatment of prostatitis include trimethoprim-sulfamethoxazole and the fluoroquinolones. Evidence indicates that fluoroquinolones may result in superior symptom control and microbiologic cure.

Topics: 4-Quinolones; Acute Disease; Anti-Infective Agents; Bacterial Infections; Chronic Disease; Humans; Male; Prostatitis; Trimethoprim, Sulfamethoxazole Drug Combination

Leukocytospermia has been associated with notable adverse effects on semen parameters and sperm function. The present study was undertaken to identify men with leukocytospermia and prostatitis in an infertility population and assess the effects of various treatments. One million white blood cells (WBC)/ml semen was defined as leukocytospermia. An expressed prostatic fluid was analyzed for the presence of white blood cells. The presence of more than 10 WBCs/high power field on expressed prostatic secretion was needed for the diagnosis of prostatitis. Those men who had more than one million WBCs in their semen and more than 10 WBCs/high power field on expressed prostatic secretion were enrolled in this study. Of two hundred sixty-three men screened for the presence of leukocytospermia and prostatitis, forty-eight men met both criteria. They were blindly and randomly assigned to one of three groups. Group 1 received no treatment. Group 2 were treated with trimethoprim 80 mg-sulfamethoxazole 400 mg (TMP-SMX) orally twice per day for one month. Group 3 were treated not only with the same antibiotic regimen as group 2 but also were instructed to ejaculate frequently (at least once every three days) for one month. Significant resolution of leukocytospermia occurred in the order of patient groups 3 > 2 > 1 at one month. The resolution rate of leukocytospermia of each group was 76% in group 3, 56% in group 2 and 6.7% in group 1. The rates in groups 2 and 3 were significantly higher than that in group 1 (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Oral; Adult; Double-Blind Method; Ejaculation; Follow-Up Studies; Humans; Infertility, Male; Leukocytes; Male; Prostatitis; Semen; Trimethoprim, Sulfamethoxazole Drug Combination

Studies of ofloxacin pharmacokinetics and pathogen susceptibilities suggested that this new fluoroquinolone might be particularly well suited to the treatment of urinary tract infections and prostatitis. Compared with carbenicillin and trimethoprim/sulfamethoxazole in separate studies of complicated urinary tract infection, ofloxacin achieved a significantly higher rate (p = 0.048) of microbiologic cures and more clinical cures than carbenicillin, while essentially matching the efficacy of the trimethoprim/sulfamethoxazole combination. Most common organisms were Pseudomonas aeruginosa in the first study and Escherichia coli in the second. In preliminary data from the prostatitis study comparing ofloxacin 300 mg given twice daily with carbenicillin 764 mg given every six hours, microbiologic cure rates were 100 percent with both medications. However, clinical cure rates were significantly higher (p = 0.048) with ofloxacin. Throughout these trials, ofloxacin has shown excellent safety and tolerability, with a lower incidence of nausea and diarrhea than with carbenicillin, and less nausea and rash than with trimethoprim/sulfamethoxazole. In all treatment groups, clinically significant laboratory abnormalities were uncommon and unrelated to the medications. Overall, these studies indicate that in complicated urinary tract infection the efficacy of ofloxacin is comparable with that of trimethoprim/sulfamethoxazole and superior to that of carbenicillin. In chronic bacterial prostatitis, results to date suggest that ofloxacin may be more effective clinically and as effective microbiologically as carbenicillin.

Topics: Administration, Oral; Adult; Aged; Bacterial Infections; Carbenicillin; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Multicenter Studies as Topic; Ofloxacin; Penicillin Resistance; Prostatitis; Random Allocation; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Norfloxacin is a lipid-soluble weak organic acid bound to plasma proteins to a low extent. Norfloxacin has a pKa1 from 6.2 to 6.4 and a pKa2 from 8.7 to 8.9. Mean concentrations of norfloxacin in prostatic tissue have been reported as 1.7 mg/kg. Recurrent urinary tract infection (UTI) in men is frequently associated with prostatic infection, and chronic prostatitis is both difficult to diagnose and to treat. One hundred and twenty-nine patients were entered into a randomized, open controlled, comparative multiclinic study of the efficacy and safety of norfloxacin vs. co-trimoxazole in male patients with recurrent UTI. Norfloxacin 400 mg and co-trimoxazole 160/800 mg were given twice daily for 4 to 6 weeks. One hundred and nine patients were considered evaluable for efficacy. Norfloxacin effected bacteriologic eradication in 56 of 60 (93%) patients; co-trimoxazole effected eradication in 39 of 49 (67%) patients. This difference in bacteriologic outcome had statistical significance (p less than 0.05). A subset of these patients had prostatic fluid cultures pre- and post-therapy. The eradication rate was 23 of 25 (92%) for norfloxacin and 10 of 15 (67%) for co-trimoxazole. Bacteria isolated were (norfloxacin/co-trimoxazole): E. coli 27/25; K-E-S 14/13; Proteus spp. 7/5; Ps. aeruginosa 2/0; other gram-negative bacilli 4/3; gram-positive cocci 7/3. Four patients, one on norfloxacin and three on co-trimoxazole had drug-related clinical and/or laboratory adverse experiences. None was serious. Norfloxacin appears to be an effective drug for the treatment of recurrent UTI in men.

Topics: Anti-Infective Agents, Urinary; Bacteria; Drug Combinations; Humans; Male; Microbial Sensitivity Tests; Norfloxacin; Prostatitis; Random Allocation; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The aim of the study was to analyze the risk factors for relapse in patients with acute bacterial prostatitis (ABP), focusing on the impact of different antibiotic regimens. We conducted an observational study of all patients diagnosed with ABP (irritative and/or obstructive urinary symptoms, temperature of >37.8°C, and the presence of bacteriuria in urine culture, in the absence of data suggesting pyelonephritis) from January 2017 to December 2018. The main outcome was relapse. We performed a multivariate analysis to identify the risk factors associated with relapse. A propensity score with inverse weighting was applied to attenuate antibiotic selection bias. We included 410 patients. The mean age was 68 years; 28.8% had diabetes mellitus, and 61.1% benign prostatic hyperplasia. The most common isolated bacteria were Escherichia coli (62.4%) and Klebsiella spp. (10%). The overall resistance rate was 39.5% to quinolones. The mortality rate was 1.2%, and the relapse rate was 6.3%. The only independent risk factor for relapse was inadequate antibiotic therapy (odds ratio [OR] 12.3; 95% confidence interval [95% CI], 3.5 to 43.1). When the antibiotic was modified according to the susceptibility pattern, the rates of relapse were 1.8% in those treated with ciprofloxacin, 3.6% with intravenous beta-lactam, 9.3% with co-trimoxazole, and 9.8% with oral (p.o.) beta-lactam (

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteriuria; beta-Lactams; Chronic Disease; Drug Resistance, Bacterial; Female; Humans; Male; Middle Aged; Prostatitis; Pyelonephritis; Quinolones; Recurrence; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

The emergence of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) infections requires re-assessment of therapeutic choices. Here we report the efficacy of cefoxitin-based antibiotic therapy for ESBL-E prostatitis. A prospective study including patients with ESBL-E prostatitis resistant to trimethoprim/sulfamethoxazole and fluoroquinolones from January 2014 to March 2016 was conducted. Cefoxitin was administered by continuous infusion for 3 weeks in the case of acute bacterial prostatitis or 6 weeks in the case of chronic bacterial prostatitis (CBP), with intravenous fosfomycin for the first 5 days. Urological investigations were performed to diagnose underlying urinary tract pathology. Clinical and microbiological efficacy were evaluated 3 months (M3) and 6 months (M6) after the end of therapy. A total of 23 patients were included in the study. The median patient age was 74 years (range 48-88 years). Of the 23 infections, 14 (61%) were CBP and 12 (52%) were healthcare-associated infections. The bacteria involved were Escherichia coli in 11 cases, Klebsiella pneumoniae in 10 cases and Klebsiella oxytoca in 2 cases. Clinical cure was observed in 19/23 patients (83%) at M3 and in 17/22 patients (77%) at M6. Urocultures were sterile in 13/23 patients (57%) at M3 and in 9/19 patients (47%) and M6. Urinary colonisation was observed in 6/19 patients (32%) with clinical cure at M3 and 5/14 patients (36%) with clinical cure at M6. No resistance to cefoxitin was detected. Surgical treatment was required for 7/23 patients (30%). In conclusion, cefoxitin-based antibiotic therapy is suitable for difficult-to-treat ESBL-E infections such as prostatitis.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; beta-Lactamases; Cefoxitin; Cross Infection; Escherichia coli; Escherichia coli Infections; Fluoroquinolones; Fosfomycin; Humans; Klebsiella Infections; Klebsiella oxytoca; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Middle Aged; Pilot Projects; Prospective Studies; Prostatitis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We report a unique case of acute bacterial prostatitis probably caused by Listeria monocytogenes in an HIV-infected patient. For the best of our knowledge, this is the first case reported of a patient with this association. Our case illustrates the protean clinical presentations that L. monocytogenes infections may adopt, particularly in immunocompromised patients.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; HIV Infections; Humans; Listeria monocytogenes; Listeriosis; Male; Prostatitis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

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.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Fosfomycin; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Prostatitis; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Tromethamine; Young Adult

To investigate the microbiologic outcome after antibiotic treatment of bacterial prostatitis in men with spinal cord injury (SCI).. A retrospective investigation was done in an SCI rehabilitation center. The microbiologic culture results of urine and ejaculate or prostatic fluid samples were collected from 34 men with SCI presenting with recurrent urinary tract infections and bacterial prostatitis. Furthermore, patient characteristics, bladder diary details, and the administered antibiotic treatment were collected.. The median age of the 34 investigated men was 42.5 years (lower quartile, 31.8; upper quartile, 46.1 years), and they had sustained SCI a median of 15.2 years (lower quartile, 4.7; upper quartile, 22.9 years) ago. The majority (24 of 34 patients; 71%) evacuated their bladder with intermittent catheterization. The most commonly used antibiotics to treat bacterial prostatitis were fluoroquinolones (n = 41) followed by trimethoprim-sulfamethoxazole (n = 8) and second-generation cephalosporins (n = 7). In merely 2 men, antibiotic treatment resulted in bacterial eradication from the prostate. A shift in the bacteria species identified in the ejaculate or prostatic fluid cultures was observed during the follow-up. Most men (28 of 34; 82%) presented with mostly the same bacteria (55 of 62, 89%) in the urine as in the ejaculate or prostate samples.. Antibiotic treatment did not result in the eradication of bacteria from the prostate of men with SCI. The antibiotic treatment of bacterial prostatitis in men with SCI should aim at eradicating symptoms and not bacteria.

Topics: Adult; Anti-Bacterial Agents; Bacterial Infections; Cephalosporins; Fluoroquinolones; Humans; Intermittent Urethral Catheterization; Male; Middle Aged; Prostate; Prostatitis; Retrospective Studies; Semen; Spinal Cord Injuries; Trimethoprim, Sulfamethoxazole Drug Combination; Urine

Topics: Chronic Disease; Combined Modality Therapy; Enterococcus; Folic Acid; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Male; Middle Aged; Prostatectomy; Prostatitis; Trimethoprim, Sulfamethoxazole Drug Combination

We present a 43-year-old man with a history of intravenous drug abuse who presented to the emergency department with a 5-week history of lower urinary tract symptoms. On digital rectal examination, a firm prostate with exquisite tenderness was noted. Computed tomography scan of the pelvis with contrast demonstrated a 4.4 by 2.7-cm prostatic abscess in the right lobe. Suppurative fluid was expressed from the right prostatic lobe during transurethral resection of the prostate. Cultures of blood and suppurative prostatic fluid grew methicillin-resistant Staphylococcus aureus.

Topics: Abscess; Adult; Bacteremia; Ciprofloxacin; Combined Modality Therapy; Community-Acquired Infections; Disease Susceptibility; Doxycycline; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Hepatitis C; Humans; Male; Methicillin Resistance; Nafcillin; Orchitis; Prostatitis; Recurrence; Staphylococcal Infections; Staphylococcus aureus; Substance Abuse, Intravenous; Suppuration; Transurethral Resection of Prostate; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Topics: Anti-Infective Agents; Diagnosis, Differential; Drug Eruptions; Histamine H1 Antagonists; Humans; Male; Middle Aged; Prostatitis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urticaria

Antibiotics are the mainstay for the treatment of men with bacterial prostatitis. Despite numerous treatment strategies involving various types, dosages and duration of antibiotics, no uniform standard has been widely adapted. Moreover, the economic burden of these therapies has been heretofore poorly described. The purpose of this study was to compare the cost effectiveness of various antibiotic treatment regimens for chronic bacterial prostatitis.. After reviewing the literature, we constructed a model that compared 90 days of double strength trimethoprim-sulfamethoxazole and 14, 28 and 60 days of ciprofloxacin 500 mg. Parameters examined included initial cure rates, relapse rates, total cure rates, pharmaceutical costs, and total cost of treatment. Using a spreadsheet Markov model, we applied cure rates and relapse rates to a hypothetical cohort of 100 men with culture positive chronic bacterial prostatitis. We then calculated cost of medications and total healthcare costs for the various drug regimens.. Twice daily ciprofloxacin @ 500 mg for 28 days proved to be the most cost effective treatment for chronic bacterial prostatitis. Yet, after sensitivity analysis, only twice daily ciprofloxacin @ 500 mg for 60 days demonstrated consistent benefit over trimethoprim-sulfamethoxazole but at a substantially increased cost.. Our model implies that ciprofloxacin 500 mg twice daily for 28 days appears to be the most cost effective treatment for chronic bacterial prostatitis. Given the limitations of this type of modeling, long term, prospective, comparative trials will provide the most definitive method of evaluating optimal therapy for chronic bacterial prostatitis.

Topics: Anti-Infective Agents; Bacterial Infections; Chronic Disease; Ciprofloxacin; Cost-Benefit Analysis; Drug Costs; Health Care Costs; Humans; Male; Markov Chains; Models, Economic; Prostatitis; Trimethoprim, Sulfamethoxazole Drug Combination

A 20-year-old Japanese woman (Case 1) and a 70-year-old Japanese man (Case 2) consulted us with slight fever and disseminated erythematous papules. Examinations revealed that the first case was a skin eruption due to trimethoprim itself and the second was due to both trimethoprim and sulphamethoxazole. To our knowledge, our Case 1 is the first reported case with an erythematous papular type skin eruption caused by trimethoprim itself, and our Case 2 is the first case of a skin eruption in reaction to both trimethoprim and sulphamethoxazole.

Topics: Adult; Aged; Anti-Infective Agents, Urinary; Cystitis; Drug Eruptions; Erythema; Female; Humans; Male; Prostatitis; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Age Factors; Aged; Bacteriuria; Escherichia coli Infections; Female; Humans; Male; Middle Aged; Prostatitis; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Two cases of Wegener's granulomatosis presenting with prostatic involvement are described and compiled with the five previously detailed cases. Each of these patients presented with obstructive symptoms, proteinuria, leukocyturia, and hematuria. The urinary sediment normalized with treatment of the underlying granulomatous vasculitis. Wegener's granulomatosis is a rare cause of prostatic obstructive symptoms, but should be considered whenever the relatively unusual entity of granulomatous prostatitis is diagnosed. One patient was initially treated exclusively with trimethoprim-sulfamethoxazole (TMP-SMX). He responded, but noted recurrence during the 15th month of treatment. We also report on this patient's antineutrophil cytoplasmic antibody (ANCA) titers, which correlated with clinical assessment and predicted recurrence 2 months before elevation of the Westergren sedimentation rate (WSR) and clinical diagnosis.

Topics: Autoantibodies; Cytoplasm; Granulomatosis with Polyangiitis; Humans; Male; Middle Aged; Neutrophils; Prostatitis; Trimethoprim, Sulfamethoxazole Drug Combination

We treated 15 men who had chronic bacterial prostatitis refractory to trimethoprim-sulfamethoxazole and/or carbenicillin with 400 mg. norfloxacin twice daily for 28 days. All pathogens were susceptible to norfloxacin and absent in prostatic fluid cultures obtained during therapy. One patient had negative post-therapy prostatic fluid cultures but was lost to followup at 1 month. Of the 14 patients followed for at least 6 months 9 (64%) were cured of the original infection, including 6 who have remained uninfected and have had negative prostatic secretion and urine cultures for at least 2 years (1), 1 year (2) or 6 months (3). In 3 patients urinary tract infections recurred with new pathogens at 6, 560 and 820 days after post-therapy negative prostatic fluid cultures. Bacterial prostatitis with the original pathogen recurred in 5 patients within 2 months of completing therapy. The bacteria remained susceptible to norfloxacin but could not be eradicated with 30 to 90 days of additional norfloxacin therapy. Cures were achieved in 9 of 12 patients with Escherichia coli, none of 2 with Pseudomonas prostatitis and 3 of 5 with prostatic calculi. No patient experienced significant adverse effects. The data suggest that norfloxacin is effective and safe for the treatment of refractory chronic bacterial prostatitis.

Topics: Carbenicillin; Chronic Disease; Escherichia coli Infections; Follow-Up Studies; Humans; Male; Middle Aged; Norfloxacin; Prostatitis; Pseudomonas Infections; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Patients with chronic prostatitis have an increased number of white blood cells in expressed prostatic secretion. Two groups can be separated, one is characterized by uropathogenic bacteria in expressed prostatic secretion and recurrent urinary tract infections, chronic bacterial prostatitis. In this group an immune response to the bacteria has been demonstrated. Patients belonging to the other group, non-bacterial prostatitis, have similar symptoms. Many harbour Gram-positive bacteria in a high number, often Staphylococcus epidermidis in expressed prostatic secretion. This bacteria is usually not considered in prostatitis in spite of extreme high numbers. The etiology of non-bacterial inflammations is thus unknown. Forty-three per cent of the patients with chronic prostatitis had Gram-positive bacteria and 13% had Gram-negative in expressed prostatic secretion. Forty-four per cent of patients referred with symptoms of prostatitis did not have any aerobic bacteria at the prostatic level in sufficient number for the diagnosis bacterial prostatitis according to Meares and Stamey and form thus a third group. Antibiotic treatment of patients with non-bacterial prostatitis reduced symptoms but also changed the bacterial flora in urethral and prostatic secretion in such a way that uropathogens were found after treatment. In a group of patients an immunologic response to Staph. epidermidis was searched for by measuring complement components (C3c, C4c) as well as ceruloplasmin in serum and immunoglobulins (IgA, IgG) in seminal plasma. A specific ELISA method to estimate antibodies in serum against Staph. epidermidis was tested. No specific pattern separated patients from controls or patients with Gram-negative bacteria from patients with Gram-positive bacteria. Staphylococcus saprophyticus in cultures from men with prostatitis were more frequent in the third quarter of the year. The bacteria seemed to appear during or after antibiotic treatment but disappeared spontaneously during a follow-up period of six months. Treatment with the surfactant sodium pentosanpolysulphate, a heparinoid, given orally to patients with chronic prostatitis reduced concomitant pain in muscles and joints. The possibility of an altered host factor function in the polymorphonuclear leucocytes of patients with chronic non-bacterial prostatitis colonized with Staph. epidermidis was investigated. Chemotaxis, phagocytosis and intracellular killing were reduced in vitro and may to a part expla

Topics: Adult; Antibodies, Bacterial; Cefadroxil; Chronic Disease; Double-Blind Method; Enzyme-Linked Immunosorbent Assay; Humans; Male; Neutrophils; Pentosan Sulfuric Polyester; Prostatitis; Staphylococcal Infections; Staphylococcus epidermidis; Trimethoprim, Sulfamethoxazole Drug Combination

The authors analysed the results of bacteriological examinations of 600 urine samples with special regard to the sensitivity of the different pathogenic agents to Sumetrolim (400 mg sulphamatoxazole + 80 mg trimethoprim per each tablet). Their observations were also summarized in tables. The effectiveness of Sumetrolim treatment (for 5 days daily 2 x 3 tablets, from the subsequent 10 days daily 2 x 1 tablet) used in 100 chronic prostatitis patients and in 100 patients suffering temporarily from chronic infection (who had undergone prostatectomy) has been analyzed. Sumetrolim has been found to be valuable in the urological practice especially in the treatment of chronic infections of long duration. Teh eventual side-effects of Sumetrolim have been discussed on the basis of references and own observations referring to the treatment of 200 patients. The therapy had to be discontinued in 21 cases, in 1 case because of toxicoderma responding well to therapy, in 3 cases because of mild cutaneous alteration, in 10 cases due to intensive diarrhoea, and in 7 cases because of other side-effects.

Topics: Bacteriuria; Humans; Male; Postoperative Complications; Prostatectomy; Prostatitis; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The bacterial flora in patients referred with chronic bacterial prostatitis were studied. Only 13% had Gram-negative bacteria in significant numbers but 43% had Gram-positives using the same criteria. Half of the patients were symptom-free by the end of a 12-week course of antibiotics and remained so after 6 months; in one-third the symptoms were unchanged 6 months after completing treatment. The relief of symptoms correlated with the disappearance of white blood cells in the expressed prostatic secretion (EPS) and with a lowered pH in the EPS. Thus only 1 of the 14 patients without symptoms at 6 months had a significant growth of bacteria at the prostatic level, whereas 7 of 10 patients with unchanged symptoms had a significant bacterial colonisation. Although the initially infecting organism was eliminated in about half of the patients, new Gram-positive bacteria were isolated after treatment in 13 of 29 patients; 12 of these resolved spontaneously within 6 months. Five patients with Gram-positive bacteria were colonised with new Gram-negatives at the end of treatment. Two healed spontaneously but 3 remained colonised with Gram-negatives at the end of the follow-up period. These findings make it likely that many patients infected with Gram-positive bacteria benefit from antibiotic treatment. However, disturbances in the bacterial flora by antibiotic treatment may facilitate invasion by new types of bacteria.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Bacterial Infections; Cefadroxil; Drug Combinations; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Male; Prognosis; Prostate; Prostatitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Staphylococcus saprophyticus was isolated in 17 percent (12 of 71 men) during one year, but with a peak in August and September to 21 percent in patients referred to the urology department with a suspicion of chronic bacterial prostatitis. Seven of the 12 men had S. saprophyticus in highest number at the prostatic level. Three of these were designated as chronic bacterial prostatitis. In this study the occurrence of S. saprophyticus appears to follow, and possibly depends on, previous antibiotic therapy. S. saprophyticus disappeared without treatment in all cases.

Topics: Adult; Cefadroxil; Chronic Disease; Humans; Incidence; Male; Prostatitis; Seasons; Staphylococcal Infections; Staphylococcus; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Doxycycline; Drug Combinations; Drug Therapy, Combination; Humans; Leukocyte Count; Male; Prostatitis; Sperm Motility; Spermatozoa; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The new fluorinated quinolones norfloxacin, ciprofloxacin and pefloxacin were evaluated in urinary infections. Bacteriological cure rates in both uncomplicated and complicated urinary tract infections ranged from 85% to 99%. Clinical cure rates were often lower due to the underlying conditions in the urinary tract. Patients with neurological bladder disease were cured in a relatively high percentage of their Pseudomonas infection after three months treatment with norfloxacin. Pharmacokinetics of ciprofloxacin in prostatic tissue and fluid will probably offer an advance in the treatment of chronic urinary infections due to an infectious prostatic focus. Definitely drug related side effects (of gastro-intestinal, neurological or allergic nature) were mild in most cases. The new 4-quinolones should be followed with interest concerning their activity in urological infections in general as well as specifically. The minor influence on the natural human flora and the possibility to decrease plasmid-mediated resistance are of major importance.

Topics: Anti-Infective Agents, Urinary; Ciprofloxacin; Drug Combinations; Humans; Male; Norfloxacin; Pefloxacin; Prostatitis; Pseudomonas Infections; Quinolines; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder, Neurogenic; Urinary Tract Infections

Plasma and prostatic fluid (PF) concentrations of co-trimoxazol (TMP/SMZ) were investigated on 16 patients with subacute or chronic prostatitis. Co-trimoxazol-forte was given perorally, 2X 1 tablet (2X 160 mg TMP/800 mg SMZ), daily. TMP-concentrations in PF were 3.3 micrograms/ml and 2.6 micrograms/ml three and six hours after peroral application (days two and three) respectively. Compared to the concentrations of TMP in plasma, there was an increase by the factor 2.0-3.7. The corresponding concentrations of SMZ in PF were 7.7 micrograms/ml and 10.4 micrograms/ml 3 and 6 hours after medication--i.e. 32% of the plasma concentrations.

Topics: Administration, Oral; Anti-Infective Agents, Urinary; Biological Availability; Chronic Disease; Drug Combinations; Humans; Kinetics; Male; Prostate; Prostatitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Adult; Bacteriuria; Diagnosis, Differential; Drug Combinations; Enterobacteriaceae Infections; Humans; Lymphogranuloma Venereum; Male; Nitrofurantoin; Pain; Pain Management; Prostatectomy; Prostatic Diseases; Prostatitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Fifty men with cytologically confirmed chronic prostatitis were treated for 3 months by consecutive p.o. administration of doxycycline, sulfamethoxazole/trimethoprim, and cephalexin. The subjective symptoms, palpatory findings, secretory capacity of the accessory genital glands (values of acid phosphatase and fructose in the seminal plasma) were evaluated. The cytologic findings from the expressed prostatic fluid and semen analysis before and after the treatment were also studied. Approximately 60% of the patients were cured of the subjective symptoms. The palpatory findings disappeared in 50% of the cases. The cytologic findings became normal in 70% of the patients (inflammatory cells less than 25/HPF). The secretory function of the prostate and the seminal vesicles was improved in 50% and 25%, respectively, of the patients, and the quantitative and qualitative motility and viability of the spermatozoa after treatment were significantly enhanced.

Topics: Administration, Oral; Adult; Anti-Infective Agents, Urinary; Cephalexin; Chronic Disease; Doxycycline; Drug Combinations; Drug Therapy, Combination; Humans; Male; Prostatitis; Spermatozoa; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Chronic non-bacterial prostatitis is a difficult condition to diagnose accurately either by symptoms and signs or by investigations. Four groups of patients were assessed for the number of leucocytes and the presence of pathogens in expressed prostatic secretions before and after treatment with co-trimoxazole two tablets twice daily for three months. The pretreatment findings suggest that the upper limit of normal for the number of leucocytes in expressed prostatic secretions is about five per microscope field (X 40 magnification) and that for the cell count about 0.5 X 10(9)/l using the method described. Increased microscopical cell estimations and cell counts in the expressed prostatic secretions of patients with symptoms of prostatitis and those with recurrent non-specific urethritis seem to indicate the presence of prostatitis.

Topics: Adult; Bacteria; Cell Aggregation; Chronic Disease; Drug Combinations; Humans; Leukocyte Count; Leukocytes; Male; Middle Aged; Prostate; Prostatitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urethritis

Review of the treatment of chronic non-bacterial prostatitis, defined by the presence of more than 500 leucocytes per mm3 in the expressed prostatic secretion (EPS), showed symptomatic response after 3 months of minocycline, trimethoprim, co-trimoxazole or diazepam. Reduction in the EPS cell count was most marked with minocycline, trimethoprim was less effective and poor results were obtained with co-trimoxazole and diazepam. In the absence of established treatment for chronic non-bacterial prostatitis it is suggested that antimicrobial therapy is worth consideration.

Topics: Adult; Anti-Infective Agents, Urinary; Chronic Disease; Diazepam; Drug Combinations; Humans; Leukocyte Count; Male; Minocycline; Prostate; Prostatitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Acute prostatitis usually is caused by aerobic gram-negative organisms or, to a lesser extent, the enterococci. The treatment of acute prostatitis requires the use of an antimicrobial with the appropriate spectrum for ten to fourteen days. However, treatment of chronic prostatitis is a more difficult therapeutic problem because of the relative impermeability of the noninflamed prostate to the majority of antimicrobial agents. The organisms most commonly responsible for chronic prostatitis include the aerobic gram-negative organisms, as well as chlamydia. Chlamydia may be the sole pathogens, or may be found as a copathogen with gram-negative organisms. Relatively few antibiotics have the appropriate physiochemical characteristics to penetrate the subacutely inflamed prostate. The most important determinant of tissue penetration in chronic prostatitis is the lipid solubility of the antibiotic, to a lesser extent its pKa (ionization potential), and the molecular size of the antibiotic. In general, penicillins, cephalosporins, and aminoglycosides do not penetrate well into the chronically inflammed prostate tissue. At the present time, the preferred agents in treating chronic prostatitis are trimethoprim or doxycycline. Doxycycline has the advantage of being active against chlamydia as well as the usual organisms that are responsible for chronic prostatitis. Therapy should be continued for two to three months.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Cephalosporins; Chlamydia Infections; Drug Combinations; Enterobacteriaceae Infections; Erythromycin; Humans; Hydrogen-Ion Concentration; Leucomycins; Male; Penicillins; Prostatitis; Sulfamethoxazole; Tetracyclines; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Humans; Infertility, Male; Male; Prostatitis; Semen; Sperm Count; Sulfates; Trimethoprim, Sulfamethoxazole Drug Combination; Zinc; Zinc Sulfate