Investig Clin Urol.  2022 May;63(3):325-333. 10.4111/icu.20210451.

Antibiotic therapy of chronic bacterial prostatitis is more effective considering antibiotic susceptibility of all pathogens isolated

• Kogan MI
• Ibishev KS
• Naboka YL
• Gudima IA
• Ferzauli AK
• Ismailov RS
• Naber KG

• KMID: 2529357
• DOI: http://doi.org/10.4111/icu.20210451

Abstract

Purpose
Because of the insufficient efficacy of the current treatment of chronic bacterial prostatitis (CBP), it is justified to search for a more effective antibiotic therapy (ABT).
Materials and Methods
This single-centre prospective observational comparative study was conducted in 2012 to 2019 (patients: 60 men with CBP; age: 20–45 y). The clinical examination was performed on admission and at 1, 3, 6, or 12 months. All patients underwent the Meares–Stamey test to obtain expressed prostatic secretion (EPS) and/or post-massage urine (PMU) samples for extended bacteriological examination. The patients were randomly divided into 2 treatment groups (30/30 patients): group I, fluoroquinolones (FQs); group II, a combination of FQs with cephalosporins/macrolides with a treatment duration of 1 month.
Results
Patients of both groups had severe symptomatic CBP with an average duration of 4 years. Twenty-three microorganisms (15 aerobes, 9 anaerobes) were identified in PMU. At 3 months follow-up, a positive clinical effect was noted in both groups, which was significant (p<0.05) only in group II concerning NIH-CPSI questionnaire, leukocyturia, prostate volume, maximum urine flow, and decreased pathospermia. At 6 months follow-up, in group II the frequency of Escherichia coli and Enterococcus spp. decreased significantly. In group I aerobes changed only insignificantly from the initial level, but anaerobes increased significantly. In group II the titers of both, aerobes and anaerobes, were significantly lower (p<0.05) at 6 months follow-up as compared to initial values.
Conclusions
ABT targeting all taxa in EPS/PMU is a more effective alternative to standard therapeutic regimens for CBP.

Keyword

Anti-bacterial agents; Bacterial load; Bacteriological techniques; Drug resistance; bacterial; Prostatitis