zithromax and Prostatitis

Chronic bacterial prostatitis (CBP) is characterized by intense clinical symptoms, frequent relapse episodes and poor quality of life. Aggressive antibacterial therapy is warranted to eradicate the causative pathogens and to achieve a permanent cure. We administered a "switch-therapy" protocol to 30 patients showing severe CBP symptoms and two or more relapse episodes in the previous 12 months. Patients received intravenous azithromycin (500 mg/day) and ciprofloxacin (800 mg/day) for 3 days, followed by oral ciprofloxacin (1 g/day) for 25 days.Twenty-seven (90%) patients showed pathogen eradication at test-of-cure (TOC) visit. Five cases of infection relapse were detected at follow-up. At the TOC visit, 25 patients (83%) showed mild/absent symptoms, measured with the NIH-chronic prostatitis symptom index.These results indicate the efficacy of a "switch-therapy" protocol, based on combined azithromycin and ciprofloxacin. Comparative studies on larger CBP patient populations are warranted to confirm these encouraging results.

Topics: Adult; Aged; Anti-Bacterial Agents; Azithromycin; Ciprofloxacin; Drug Therapy, Combination; Follow-Up Studies; Humans; Male; Middle Aged; Pilot Projects; Prospective Studies; Prostatitis; Secondary Prevention

Topics: Adult; Aged; Anti-Bacterial Agents; Azithromycin; Chlamydia trachomatis; Chlamydiaceae Infections; Diagnosis, Differential; DNA, Bacterial; Fluorescent Antibody Technique, Direct; Humans; Male; Middle Aged; Prospective Studies; Prostatitis; Urinalysis; Urine

The study included 125 adult patients (> 18years of age) who had symptoms of chronic prostatitis and proven presence of Chlamydia trachomatis. The presence of C. trachomatis was confirmed in expressed prostatic secretion or in voided bladder urine collected immediately after prostatic massage by a DNA/RNA hybridization method and/or by isolation on McCoy culture and then by immunofluorescent typing with monoclonal antibodies. The patients were randomized in the ratio 2/1; azithromycin/doxycycline, to receive a total of 4.0 g azithromycin over 4 weeks, given as a single dose of 1 x 1000 mg weekly for 4 weeks or doxycycline 100 mg b.i.d. for 28 days. Patients' sexual partners were treated at the same time. Clinical and bacteriological efficacy was evaluated 4-6 weeks after the end of therapy. In the group of patients with chlamydial infection of the prostate, there was no significant difference between the eradication rates (azithromycin 65/82, doxycycline 33/43; P = 0.82) and the clinical cure rates (azithromycin 56/82, doxycycline 30/43; P = 0.94) of the two antimicrobials.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Doxycycline; Humans; Male; Middle Aged; Prostatitis; Treatment Outcome

Topics: Adult; Aged; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Chronic Disease; Dose-Response Relationship, Drug; Drug Administration Schedule; Follow-Up Studies; Humans; Male; Middle Aged; Prospective Studies; Prostatitis; Treatment Outcome

To assess the clinic efficacy of treating chronic prostatitis by Neisseria gonorrhoeae with azithromycin aspartic-acid injection.. Nineteen cases were treated with monotherapy and once-daily intravenous dosing of azithromycin injection. The effects and side-effects after treatment were observed.. Twelve of nineteen cases were cured.. A short term therapy with azithromycin injection for chronic prostatitis caused by Neisseria gonorrhoeae is very effective and easy to used and thus eliminate any problem of compliance.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Gonorrhea; Humans; Injections, Intravenous; Male; Middle Aged; Neisseria gonorrhoeae; Prostatitis; Treatment Outcome

A total of 89 patients, (>18 years), with symptoms of chronic prostatitis and inflammatory findings as well as the presence of Chlamydia trachomatis confirmed by DNA/RNA DIGENE hybridization method and/or by isolation, McCoy culture and Lugol stain in expressed prostatic secretion or in voided bladder urine collected immediately after prostatic massage, were examined. The patients were randomized to receive a total of 4.5 g of azithromycin for 3 weeks, given as a 3-day therapy of 1 x 500 mg weekly or ciprofloxacin 500 mg b.i.d. for 20 days. Patients' sexual partners were treated at the same time. Clinical and bacteriological efficacy were evaluated 4-6 weeks after the end of therapy. Significantly higher eradication (36/45: 17/44; P=0.0002) and a significantly higher clinical cure (31/45: 15/44; P=0.0021) were achieved in the group of patients treated with azithromycin than in the ciprofloxacin group.

Topics: Adolescent; Adult; Aged; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Chronic Disease; Ciprofloxacin; Humans; Male; Middle Aged; Prostate; Prostatitis

A total of 123 patients, older than 18 years of age, with symptoms of chronic prostatitis and inflammatory findings as well as the presence of Chlamydia trachomatis confirmed by DNA/RNA DIGENE hybridization method in expressed prostatic secretion or in voided bladder urine collected immediately after prostatic massage, were examined. The patients were randomized to receive a total of 4.5 g of azithromycin for 3 weeks, given as a 3-day therapy of 1 x 500 mg weekly or clarithromycin 500 mg b.i.d. for 15 days. Patients' sexual partners were treated at the same time. Clinical and bacteriological efficacy were evaluated 4-6 weeks after the end of therapy. In the group of patients with chronic chlamydial prostatitis the eradication rates (azithromycin 37/46, clarithromycin 36/45) and the clinical cure rates (azithromycin 32/46, clarithromycin 32/45) were not significantly different with regards to the administered drug (p > 0.05). In the group of patients with asymptomatic chlamydial prostatitis the eradication rates (azithromycin 11/16, clarithromycin 10/15) were not significantly different with regards to the administered drug (p = 1.00, OR = 1.1).

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Chronic Disease; Clarithromycin; Dose-Response Relationship, Drug; Humans; Male; Maximum Tolerated Dose; Middle Aged; Prospective Studies; Prostatitis; Treatment Outcome

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%.. This was a retrospective observational study to investigate the efficacy of levofloxacin against CBP in a real-life setting (urological outpatient wards).. 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.. 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.. 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.

Topics: Adult; Aged; Anti-Bacterial Agents; Azithromycin; Candida albicans; Drug Therapy, Combination; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Levofloxacin; Male; Middle Aged; National Institutes of Health (U.S.); Prostate; Prostate-Specific Antigen; Prostatitis; Retrospective Studies; Treatment Outcome; United States; Young Adult

Topics: Aged; Anti-Bacterial Agents; Azithromycin; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Humans; Male; Prostatitis

We previously demonstrated the safety and efficacy of fluoroquinolone-macrolide combination therapy in category II chronic bacterial prostatitis (CBP). The aim of this study is to retrospectively compare the microbiological and clinical findings of two treatment schemes for CBP based on the combination of azithromycin (500 mg, thrice-weekly) with a once-daily 500- or 750-mg dose of ciprofloxacin (Cipro-500 or Cipro-750 cohort, respectively). Combined administration of azithromycin (1500 mg week(-1)) with ciprofloxacin at the rate of 750 mg day(-1) for 4 weeks rather than at 500 mg day(-1) for 6 weeks increased the eradication rates from 62.35% to 77.32% and the total bacteriological success from 71.76% to 85.57%. A significant decrease in pain and voiding signs/symptoms and a significant reduction in inflammatory leukocyte counts and serum prostate-specific antigen (PSA) were sustained throughout an 18-month follow-up period in both groups. Ejaculatory pain, haemospermia and premature ejaculation were significantly attenuated on microbiological eradication in both groups, but the latter subsided more promptly in the Cipro-750 cohort. In total, 59 Cipro-750 patients showed mild-to-severe erectile dysfunction (ED) at baseline, while 22 patients had no ED on microbiological eradication and throughout the follow-up period. In conclusion fluoroquinolone-macrolide therapy resulted in pathogen eradication and CBP symptom attenuation, including pain, voiding disturbances and sexual dysfunction. A once-daily 750-mg dose of ciprofloxacin for 4 weeks showed enhanced eradication rates and lower inflammatory white blood cell counts compared to the 500-mg dose for 6 weeks. Our results are open to further prospective validation.

Topics: Anti-Bacterial Agents; Azithromycin; Bacterial Infections; Chronic Disease; Ciprofloxacin; Cohort Studies; Drug Therapy, Combination; Fluoroquinolones; Humans; Macrolides; Male; Prostatitis; Retrospective Studies

To investigate the association between eradication of Chlamydia trachomatis (CT) and symptom regression in chronic prostatitis, 55 symptomatic patients were subjected to segmented tests to localise CT in first voided urine (VB1), prostatic secretions (EPS), post-massage voided (VB3) or semen specimens. Patients were divided in three treatment groups: the 'urethral involvement' group ('U': VB1 positive, EPS/VB3/Semen negative) was treated with 500 mg day(-1) azithromycin for 3 days. The 'prostatitis' group ('P': VB1 negative, EPS/VB3/semen positive) with 4-week levofloxacin-azithromycin combination. A third group, 'U+P' (VB1, EPS/VB3/semen positive) received both treatments in sequence. In P patients, eradication of CT was paralleled by marked, sustained symptom improvement and by significant decrease of serum prostate-specific antigen (PSA) levels. Compared with U patients, undergoing rapid regression of symptoms related to painful micturition after short-term azithromycin, U+P patients showed symptom and pathogen persistence in VB3/EPS/semen and required additional treatment with 4-week levofloxacin-azithromycin to achieve pathogen eradication, symptom regression, and decrease of PSA. Our results support a causative role of CT in chronic bacterial prostatitis. In the presence of a positive urethral localisation of the pathogen, thorough microbiological investigation together with focused symptom analysis may reveal an underlying chlamydial prostatitis and direct effective therapy with appropriate antibacterial agents.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Drug Therapy, Combination; Humans; Levofloxacin; Male; Middle Aged; Ofloxacin; Prostate-Specific Antigen; Prostatitis; Semen; Urethra

We examined a total of 1014 patients over 18 years of age; 252 with urethritis and 762 with chronic prostatitis syndrome. the mean age of patients with urethritis was 32.7 and with prostatitis syndrome 37.6 years. Clinical symptoms of urethritis were present from a few days to several months. in patients with chronic prostatitis syndrome, symptoms were present for at least 3 months. Chlamydia trachomatis alone was confirmed in 26 (10%) and in combination with Ureaplasma urealyticum in 6 (2%) patients with urethritis. in 171 (68%) patients with urethritis neither C. trachomatis nor U. urealyticum or Mycoplasma hominis were found. C. trachomatis alone was confirmed in 70 (9%), and in combination with other microorganisms in 7 (1%) patients with chronic prostatitis syndrome. in Croatia, the frequency of chronic chlamydial prostatitis has not significantly changed in the last 10 years, while the frequency of infections among adolescents decreased. the recommended regimen for acute chlamydial urethritis in Croatia is azithromycin 1.0 g as a single dose, and a total dose of 4-4.5 g azithromycin for chronic chlamydial prostatitis.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Chronic Disease; Croatia; Humans; Male; Prostatitis; Urethritis

We identified from our clinical database a total of 471 patients affected by cat. II chronic bacterial prostatitis (CBP), cat. III (IIIa and IIIb) chronic pelvic pain syndrome (CP/CPPS), or cat. IV asymptomatic inflammatory prostatitis (AIP), according to NIH criteria. 132 intent-to-treat patients, showing levels of PSA > or =4 ng/mL, were subjected to a 6-week course of combination pharmacological therapy with 500 mg/day ciprofloxacin, 500 mg/day azithromycin (3 days/week), 10 mg/day alfuzosin and 320 mg b.i.d. Serenoa repens extract. At the end of treatment, 111 per-protocol patients belonging to all categories of prostatitis showed a total 32.5% reduction of PSA levels. In the same group, 66 patients (59.4%) showed "normalization" of PSA values under the 4 ng/mL limit. Patients affected by cat. IIIb CP/CPPS showed the highest PSA reduction and normalization rates (40% and 68.4%, respectively). Follow-up data show that, after a marked, significant reduction at completion of therapy, PSA levels, urine peak flow rates and NIH-CPSI symptom scores remained constant or decreased throughout a period of 18 months in patients showing normalization of PSA values. Prostatic biopsy was proposed to 45 patients showing persistently high PSA values (> or = 4 ng/mL) at the end of treatment. Fourteen patients rejected biopsy; of the remaining 31, 10 were diagnosed with prostate cancer. Four months after a first biopsy, a second biopsy was proposed to the 21 patients with a negative first diagnosis and persistently elevated PSA levels. Three patients rejected the procedure; of the remaining 18, four were diagnosed with prostatic carcinoma. In summary, combination pharmacological therapy decreased the number of patients undergoing prostatic biopsy from 111 to 45. Normalization of PSA values in 59.4% of patients--not subjected to biopsy--increased the prostate cancer detection rate from 12.6% (14/111) to 31.1% (14/45). The reduction of PSA after a 6-week course of therapy was calculated in patients affected by cat. II, IIIa, IIIb and IV prostatitis after stratification with respect to the concomitant presence or absence of benign prostatic hyperplasia (BPH). PSA was reduced by 41% in cat. II CBP patients without BPH, compared to a 12.7% reduction in patients affected by BPH. Cat. IIIa CP/CPPS patients without BPH showed a 58.3% reduction of PSA levels, compared to a 20.7% reduction observed in CPPS/BPH patients. These data show that the presence of BPH may prevent the red

Topics: Adrenergic alpha-Antagonists; Adult; Aged; Algorithms; Androgen Antagonists; Anti-Bacterial Agents; Anti-Infective Agents; Azithromycin; Biomarkers, Tumor; Biopsy; Ciprofloxacin; Drug Therapy, Combination; Humans; Male; Middle Aged; Plant Extracts; Predictive Value of Tests; Prostate-Specific Antigen; Prostatic Neoplasms; Prostatitis; Quinazolines; Retrospective Studies; Serenoa

We performed a comparative analysis of microbiological and clinical responses to combination therapy in 104 symptomatic patients showing evidence of infection by traditional uropathogens (TU) or by unusual pathogens (UP) at the prostatic level. Eighty-two pathogens out of a total of 104 isolated microorganisms were eradicated at the end of a 6-week course of combination therapy with ciprofloxacin, azithromycin, alfuzosin and a S. repens extract. The TU and UP groups showed eradication rates of 75.5% and 82.3%, and clinical success rates of 78.8% and 85.7%, respectively. Thus, a similar response to therapy was observed in patients infected by TU or by UP. Intergroup differences were not significantly different, with the exception of higher scores relative to the impact of the disease on quality of life in TU-patients. Long-term improvement of signs and symptoms of prostatitis indicates that combination therapy is beneficial for symptomatic patients showing evidence of infection by unusual pathogens at the prostatic level. Our data support the hypothesis that organisms other than the traditionally recognized uropathogens may play a role in the onset of prostatitis.

Topics: Adrenergic alpha-Antagonists; Adult; Androgen Antagonists; Anti-Bacterial Agents; Anti-Infective Agents; Azithromycin; Bacterial Infections; Ciprofloxacin; Drug Therapy, Combination; Humans; Male; Middle Aged; Plant Extracts; Prostatitis; Quinazolines; Serenoa; Treatment Outcome

The antibacterial susceptibility of Chlamydia trachomatis in 138 patients with chronic prostatitis (CP) and clinical failures after antibacterial treatment with azithromycin (AZI) were investigated. Azithromycin was not found to be top-of-the-line drug in the follow-up treatment, showing only average results in vitro. The investigation of the susceptibility of chlamydia to antibiotics in causes of chronic prostatitis is highly recommended.

Topics: Anti-Bacterial Agents; Azithromycin; Bacterial Infections; Chlamydia Infections; Chlamydia trachomatis; Chronic Disease; Humans; Male; Microbial Sensitivity Tests; Prostatitis

Little is known about chlamydia survival in the presence of fluoroquinolones in patients with chronic prostatitis syndrome (CPS). In vitro activities of four fluoroquinolones, azithromycin and doxycycline against C. trachomatis in patients with CPS being not treated with antibiotics earlier were investigated and compared.. Chlamydia survival in 304 patients with CPS being not treated with antibiotics earlier was analysed and compared. Infection by C. trachomatis was determined in the urethra and expressed prostatic secretion by cell culture test.. Azithromycin and ofloxacin were found to be the most active antichlamydial agent with ciprofloxacin and doxycycline being least active.. Ofloxacin can be recommended as the primary drug in the treatment of chlamydia-infected patients with CPS. The decision on the prescription of other fluoroquinolones should be made individually. The investigation of chlamydia survival in the presence of antibiotics in patients with CPS and C. trachomatis prior to treatment is recommended.

Topics: Adult; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Doxycycline; Fluoroquinolones; Humans; In Vitro Techniques; Male; Microbial Sensitivity Tests; Middle Aged; Prostatitis

To investigate the cause of chronic pelvic pain syndrome (CPPS) and the correlation between presence of bacterial signal and the response to antibiotics by detecting bacterial 16S rRNA gene signal using polymerase chain reaction (PCR).. EPS and first void urine (VB1) from 59 men with CPPS were analyzed by PCR for bacterial signal using universal primers specific for bacterial 16S rRNA gene. If the bacterial signal was found only in EPS or the EPS bacterial signal was at least 10 times stronger than the VB1 one, positive result could be decided for bacterial signal detection. All patients were treated with levofloxacin and azithromycin for 4 weeks. The treatment could be considered effective if more than 50% improvement, compared to the state before the treatment, was achieved in the symptom severity index(SSI), symptom frequency questionnaire(SFQ), national institutes of health chronic prostatis symptom index of pain(quasi-CPSI) or the patients' general subjective assessment.. Positive bacterial signal was detected in 46 of the 59 CPPS patients; The difference of improvement rates between positive bacterial signal group and negative bacterial signal group, which were 65%-74% and 0 respectively, was significant.. The basis of detecting 16S rRNA gene signal by PCR in clinical practice was built. The study shows that bacterial infection is related to CPPS. Bacterial signal detection results can help predict the effect of antimicrobial therapy.

Topics: Anti-Bacterial Agents; Azithromycin; Chronic Disease; Humans; Levofloxacin; Male; Ofloxacin; Pelvic Pain; Polymerase Chain Reaction; Prostatitis; RNA, Bacterial; RNA, Ribosomal, 16S

Topics: Anti-Bacterial Agents; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Chronic Disease; Humans; Male; Prostatitis

Chlamydia trachomatis (C.t.) cell culture represents a sensitive method for the diagnosis of chlamydial infection and the only one which makes it possible to determine the susceptibility of an isolate to antibiotics so that an appropriate drug can be selected for individual treatment. In 11 patients, affected by urethroprostatitis and suspected of treatment failure with standard drug regimens, either due to lack of compliance with therapy or antibiotic resistance, C.t. was isolated in McCoy cell culture from urethral swabs, after prostatic massage. The in vitro activity of azithromycin against these isolates and the in vivo efficacy of the drug in the patients treated with a single 1 g dose have been evaluated. All the C.t. strains tested were susceptible to the action of azithromycin (MIC range 0.125-1.0 microgram/ml). Bactericidal values were one dilution higher (MBC range 0.25-2.0 microgram/ml). These in vitro results are consistent with clinical observations as all the patients treated had negative culture at a 4-week follow-up visit.

Topics: Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Humans; Male; Microbial Sensitivity Tests; Prostatitis; Urethral Diseases