Antibiotic treatment of bacterial chronic and acute prostatitis. Bacterial prostatitis: tactics for choosing a therapy regimen. Causes of bacterial prostatitis

The term prostatitis means a disease of the prostate gland of inflammatory and infectious genesis, isolated or combined with damage to the seminal vesicles and tubercle, as well as the urethra (its back).

The disease can occur in acute (as a rule, occurs from 30 to 50 years old) and chronic form.

Chronic prostatitis develops as a result of stagnant processes in the gland or may be the result of an undertreated acute disease. It is characterized by slow development and cicatricial-sclerotic changes in the tissue of the organ. It is important not to confuse it with benign prostatic hyperplasia (adenoma) - an age-related involution that occurs as a result of the growth of the periurethral gland and causes urinary tract obstruction.

The goal of treatment will be to eliminate clinical symptoms and reduce the risk of complications, as well as the complete restoration of copulatory function and fertility. Antibiotics for prostatitis and adenoma are prescribed to eliminate the etiological bacterial factor. Antimicrobial therapy for adenoma is also used in the case of planned hospitalization in a surgical hospital, in order to prevent postoperative infectious and inflammatory complications.

The main symptoms of prostatitis are:

not sharp, aching, pulling pains in the perineum, radiating to the rectum, testicles, glans penis, sacrum, rarely - to the lower back;
dysuric disorders, especially in the morning, a constant feeling of incomplete emptying of the bladder;
loose secretion after urination;
increased pain during a long stay in a sitting position and their decrease after walking;
erectile disorders, premature ejaculation, impotence;
violation of the general condition, nervousness, decreased performance, insomnia.

When confirming the diagnosis, they rely on the results of a digital examination, indicators of a general blood and urine test, prostate secretion, a 2-cup sample after massage, spermogram, hormonal profile, and ultrasound. If necessary, a differential diagnosis with adenoma, a biopsy is performed.

Drugs of choice or the best antibiotics for prostatitis in men

Fluoroquinolones are the "gold standard" of treatment.

Ciprofloxacin ® (Cifran ® , Cifran OD ® , Tsiprobay ® etc.)

An antibacterial agent with a wide spectrum of antimicrobial effects, which is due to its ability to inhibit the DNA gyrase of pathogens, disrupting the synthesis of the tank. DNA and leading to irreversible changes in the microbial wall and cell death.

Ciprofloxacin ® has no effect on ureaplasma, treponema and Clostridium difficile.

Antibiotic is contraindicated:

up to eighteen years of age;
in the presence of colitis caused by taking antimicrobial agents in history;
in case of individual hypersensitivity to fluoroquinolones;
patients with porphyria, severe renal and hepatic insufficiency;
simultaneously with Tizanidin ® ;
epileptics and persons with severe lesions of the central nervous system;
in violation of cerebral circulation;
in patients with tendon injury associated with fluoroquinolones.

Features of the appointment of Ciprofloxacin ®

To reduce the risk of adverse events, it is recommended for the duration of therapy:

exclude physical activity and excessive insolation;
use creams with high SPF;
increase drinking regimen.

Ciprofloxacin ® is not combined with non-steroidal anti-inflammatory drugs, due to the high risk of seizures. It is also able to enhance the toxic effect on the kidneys of Cyclosporine ® .

When combined with Tizanidine ®, a sharp drop in blood pressure is possible, up to collapse.

Use during anticoagulant therapy may cause bleeding. Enhances the effect of hypoglycemic tablets, increasing the risk of hypoglycemia.

When combined with glucocorticosteroids, the toxic effect of fluoroquinolones on tendons increases.

In combination with beta-lactams, aminoglycosides, metronidazole and clindamycin, a synergistic interaction is observed.

Unwanted effects from treatment

violation of the digestive tract;
neurosis, anxiety, hallucinations, nightmares, depression;
tendon ruptures, arthralgia, myalgia;
arrhythmias;
taste perversion, decreased sense of smell, impaired visual acuity;
nephritis, impaired renal function, crystalluria, hematuria;
cholestatic jaundice, hepatitis, hyperbilirubinemia;
decrease in the number of platelets, leukocytes, hemolytic anemia;
photosensitivity;
hearing loss (reversible);
lowering blood pressure;
colitis and diarrhea.

Calculation of the dose and duration of treatment

500 to 750 milligrams twice a day. When using drugs with prolonged action (Cifran OD ® 1000 mg), a single dose is possible. The maximum dose per day is 1.5 grams.

In a severe form of the disease, therapy begins with intravenous administration, with a further transition to oral administration.

The duration of treatment depends on the severity of the disease and the presence of complications. The standard course of therapy is from ten to 28 days.

How to treat bacterial prostatitis (acute and chronic) in men with antibiotics?

To eradicate the pathogen and eliminate the inflammatory process, broad-spectrum drugs are used that work against the most common pathogens.

I) Fluoroquinolones:

Norfloxacin ® (Nolicin ® , Norbactin ®);
Ciprofloxacin ® (Ciprolet ® , Tsiprobay ® , Cifran OD ® , Ciprinol ® , Quintor ® , Quipro ®);
Levofloxcin ® (Tavanik ® , Glevo ® , Levolet R ®);
Ofloxacin ® (Tarivid ® , Zanonin OD ®);
Moxifloxacin ® (Avelox ®).

II) Fluoroquinolones in combination (the best antibiotics for prostatitis caused by mixed infection):

Ofloxacin ® + Ornidazole ® (Ofor ® , Polymic ® , Combiflox ®);
Ciprofloxacin ® + Tinidazole ® (Cifran ST ® , Tsiprolet A ® , Tsiprotin ® , Zoxan TZ ®);
Ciprofloxacin ® + Ornidazole ® (Orcipol ®).

III) Cephalosporins:

Cefaclor ® (Vercef ®);
Cefuroxime-axetil ® (Zinnat ®);
(Cefabol ®);
Ceftriaxone ® (Rofecin ®);
Cefoperazone ® (Medocef ® , Cefobit ®);
(Fortum®);
Cefoperazone/sulbactam ® (Sulperazone ® , Sulzoncef ® , Bakperazone ® , Sulcef ®);
Cefixime ® (Supraks ® , Sorcef);
Ceftibuten ® (Cedex ®).

IV) Inhibitor-protected penicillins (Axicillin/Clavulanic acid ®):

Augmentin ® ;
Amoxiclav ® ;
Ranklav ® ;
Panklav ® .

The drug is not prescribed:

persons with individual hypersensitivity to macrolides;
severe diseases of the kidneys and liver;
against the background of the use of ergotamine and dihydroergotamine;
with severe arrhythmias.

It is used with caution in patients with myasthenia gravis, heart failure, hypokalemia and hypomagnesemia, impaired renal and hepatic function of mild to moderate severity.

Side effect of the drug

Gastrointestinal disorders of a dyspeptic nature, transient increase in liver transaminases, jaundice, dysbacteriosis, fungal infection of the mucous membranes, insomnia, headaches, allergic reactions, photosensitivity are possible.

Medicinal combinations

Alcohol, food and antacids reduce the bioavailability of Sumamed ® . Not recommended for persons receiving anticoagulants. Poorly combined with oral hypoglycemic agents, there is a risk of hypoglycemia. Shows antagonistic interaction with lincosamides and synergistic with and Tetracycline ® . Has a farm. heparin incompatibility.

Effective treatment of bacterial prostatitis largely depends on how the disease is classified (acute or chronic) and what type of infectious agent it is.

This is determined by the diagnosis of the disease: the symptoms of the disease, possible causes, etc. are determined.

Treatment for bacterial prostatitis can be pharmacological or non-pharmacological.

Drug treatment of bacterial prostatitis can be represented as follows:

taking antibiotics;
taking alpha-blockers if you have problems with urination. These funds help to relax smooth muscle cells in the walls of the bladder and urethra, which normalizes the process of urination;
taking non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain caused by inflammation in the prostate gland. You may be prescribed drugs from the Diclofenac or Ibuprofen group;
if in the course of treatment a man experiences mood swings or the development of depression, then sedatives are additionally prescribed.

Non-drug treatments for bacterial prostatitis include:

folk remedies (usually herbal treatment);
organization of proper nutrition (special diets);
physiotherapy.

Disease prevention plays an important role.

Folk remedies for the treatment of bacteria with prostatitis: we select the right diet, we do physiotherapy, we prescribe prevention

Treatment at home:

Pumpkin seeds are extremely effective. It is enough to take 30 seeds per day. The beneficial effect is explained by the fact that pumpkin seeds contain a large amount of zinc, which contributes to the treatment of prostatitis.
Vegetable juice made at home. It is extremely useful to use asparagus. Beets, carrots and cucumbers will also be useful. You need to drink about 50 grams of such freshly squeezed juice per day.
Useful is a decoction of chestnut shells. This decoction should replace the intake of tea and drink it throughout the day.

Physiotherapy

Physiotherapy is prescribed only in two cases: 1 - the man recovered, 2 - the chronic process worsened.

In case of prostatitis, self-treatment is unacceptable.

After examining the patient, the doctor may prescribe the following types of physiotherapy:

prostate massage;
magnetotherapy;
UHF therapy;
laser therapy;
hirudotherapy.

Diet

When organizing proper nutrition, it is strictly forbidden to include the following products in your diet:

Coffee and carbonated drinks.
Juices in tetra-packs.
Alcoholic drinks.
Products for fast food.
Canned products.
Semi-finished products.
Fatty, spicy, smoked and pickled foods.

With improper treatment of bacterial prostatitis (or no treatment), the following complications are possible:

The development of blood clots in the vessels that supply the prostate with blood.
Formation of stones in the prostate.
Manifestation of purulent abscesses in the prostate.
development of prostate adenoma.
The formation of benign prostatic hyperplasia.
Development of erectile dysfunction.
Formation of tumors in the prostate gland (prostate cancer).

Proper prevention of bacterial prostatitis will help reduce the risk of developing the disease, namely:

Proper nutrition, which consists in organizing a suitable diet: healthy foods and observing the hours of eating.
Regular sexual contacts.
Active lifestyle.
Proper clothing so as not to overheat and not overcool the body.
Rejection of all bad habits: stop drinking alcohol and smoking.

Treatment of chronic bacterial prostatitis is a long and complicated process, since the infection persists in the prostate for a long time. Even in cases where the symptoms of the disease have disappeared, it is necessary to drink a full course of antibiotics, since the infection may persist without symptoms. For the treatment of chronic bacterial prostatitis, it is necessary to identify the type of infection in order to select the appropriate drug, to which the pathogen is hypersensitive.

Acute bacterial prostatitis manifests itself through severe fever. Chills and pain in the lower abdomen appear suddenly, urination is difficult. Treatment consists in the timely administration of antibiotics.

If acute bacterial prostatitis is not treated, it will become chronic.

Antibacterial drugs for prostatitis: what is better to choose

Antibacterial drugs for prostatitis are the main medical treatment for bacterial prostatitis.

Treatment of bacterial prostatitis with antibiotics and antimicrobial agents can be carried out by taking drugs from the following groups:

protected penicillins;
macrolides;
tetracyclines;
cephalosporins;
fluoroquinols.

You can make your own suppositories for the treatment of bacterial prostatitis. Propolis is perfect for this. It is necessary to evaporate 40 grams of propolis in a glass of alcohol. Then 0.1 g of the extract is mixed with 2 g of cocoa butter. Small candles are molded from the resulting mixture. At night, such a candle should be inserted into the rectum. The procedure should be carried out within a month.

Treatment of bacterial prostatitis with antibiotics: list of drugs and treatment regimen

Currently, the treatment of bacterial prostatitis with antibiotics is carried out as follows:

a group of aminoglycosides: taking Gentamicin, Kanamycin, 5-NOC;
a group of cephalosporins: the appointment of Ceftriaxone;
penicillin group: taking Amoxiclav;
tetracycline group: taking doxycycline or tetracycline;
group of macrolides: the appointment of Azithromycin, Sumamed, Clarithromycin, Oleandomycin;
a group of fluoroquinolones: taking Norfloxacin, Ciprofloxacin Ofloxacin. Fluoroquinolones have a lower ability to penetrate the prostate tissue, but these drugs are prescribed if other antibiotics are contraindicated in the male body.

Treatment regimen for bacterial prostatitis

A man should be examined to identify the type of pathogen (the sensitivity of microorganisms to drugs of a particular group) and prescribe the necessary antibiotic. This analysis is carried out using the study of prostate juice.

Antibiotics in the treatment of bacterial prostatitis should be drunk for an average of two weeks. Then re-analyze the juice of the prostate. If the pathogen is found again, then antibiotics may be extended for a week or replaced with another type of medication. If the treatment is carried out in a timely manner and with properly selected antibiotics, then prostatitis will be completely cured. Otherwise, the disease may become chronic.

Often, it is precisely the right antibiotic therapy in the early stages of the development of prostatitis that makes it possible to avoid the most undesirable consequences in the future.

Prostatitis in men develops mainly under the influence of two main reasons. This is the penetration of various bacteria into the tissues of the organ and the violation of blood circulation in the pelvis.

Antibiotics for prostatitis are especially effective if the bacterial nature of the origin of the disease is proven.

Without antibiotic therapy, it is impossible to cope with the inflammatory reaction, which causes all the symptoms of acute prostatitis.

The course of antibiotics in each case is selected individually. The doctor also calculates the general treatment regimen.

In the acute period of bacterial prostatitis, the refusal to use antibiotics leads to the most undesirable consequences, and the most important of them are prostate adenoma and gradually developing impotence.

Also, if the bacterial flora is not destroyed, it can negatively affect other organs, primarily the bladder and kidneys. That is, untreated prostatitis can also cause cystitis, pyelonephritis, and later urolithiasis.

Antibiotics in the treatment of prostatitis are also necessary in a chronic inflammatory process.

Often a sick man does not immediately go to the doctor. Many patients try to be treated with folk remedies and the acute phase of the disease subsides on its own, but this does not lead to the complete elimination of the infection.

This means that in order to cope with bacteria, a course of antibiotic therapy must also be obtained in the chronic form of prostatitis.

Often, repeated antibiotic treatment regimens are prescribed in order to prevent another exacerbation of the disease.

Modern antibiotics for the most part have a wide spectrum of action, that is, they can destroy several types of bacteria simultaneously present in the human body.

But in order to successfully cure prostatitis, it is necessary to know which pathogens have influenced inflammation in the tissues of the prostate gland and whether they are sensitive to a certain group of drugs.

Acute prostatitis can be caused by both venereal disease pathogens, that is, chlamydia, gonococci, Trichomonas, and various streptococci and even E. coli.

Each type of these bacteria reacts in a certain way to the components of antibiotics and the task of the doctor is to find the optimal drug that will help to quickly destroy the pathogen and will not have a negative effect on the cells of the prostate gland.

Therefore, before prescribing an antibacterial treatment regimen, the patient must pass several tests.

To determine the causative agent of the disease, a prostate secret and a general urine test are needed;
The degree of inflammation is determined by blood tests;
Sensitivity to antibiotics shows bacteriological culture.

Based on the tests performed, the doctor selects the most effective drug. Depending on the stage of the inflammatory process and the patient's well-being, the antibiotic can be both in tablets and in injections.

The doctor also evaluates the ability of the components of the drug to penetrate into the tissues of the gland.

First of all, the drug is selected that quickly penetrates into the organ and lingers in it at the required concentration. Such treatment provides rapid elimination of inflammation and discomfort.

Injectables are usually stronger.

Antibiotics for prostatitis in the event that the patient turned to the urologist in the acute stage of inflammation are prescribed almost immediately. That is, the doctor will not wait for these tests.

Therefore, in the first days, a medicine with a wide spectrum of action is selected, the selection scheme is very similar in the selection of antibiotics for cystitis.

Preference is given to:

macrolides.

aminoglycosides.

fluoroquinolones.

Antibiotics from the erythromycin group are prescribed less frequently, since they are not able to have a detrimental effect on several bacteria at once.

After laboratory data are received by the doctor, it usually takes two to three days, a decision is made either to continue the selected therapy regimen, or to prescribe a new, more effective drug.

When choosing a medicine, the doctor must take into account the age of the patient, the presence of certain somatic diseases in his anamnesis, and allergic reactions.

The patient, in turn, must warn the doctor about the antibiotics he has previously used.

If a man was treated with any medicine a few weeks before prostatitis, then it is likely that at this stage it will not be as effective as necessary to relieve inflammation.

Among the different groups of antibiotics there are so-called "reserve" drugs, they include drugs with a strong effect on the body. The urologist prescribes them only if the previous conservative treatment has not helped.

This may be evidenced by the lack of effect of therapy and the presence of the causative agent in repeated analyzes.

Strong antibiotics are mainly used in injections and therefore they are put into a vein or intramuscularly in a hospital setting.

For home treatment, antibiotics are selected in tablets, when using them, the doctor must tell in detail the entire treatment regimen.

Antibacterial therapy requires compliance with certain conditions.

Antibiotics are prescribed for a certain period of time. Usually it is at least 2 weeks. In the future, the doctor evaluates the condition of the prostate gland and cancels the drug, or advises continuation of treatment;
The dosage of the drug is also selected individually;
The entire course of treatment must be completed. If it is interrupted, then the body develops suitable conditions for the transition of an acute infectious process into a chronic one;
From the moment you start using antibiotics to reduce pain and discomfort, no more than three days should pass. If after this period the condition has not improved, then you need to re-consult a doctor for a review of therapy and the selection of another antibiotic.

Antibiotic therapy is one of the most important conditions for complete recovery from bacterial prostatitis. A sick man should understand that his trouble-free life in the future depends on compliance with the entire treatment regimen.

Several decades have passed since the invention of antibiotics. And if at the beginning of their use the choice of groups of drugs was limited only to the penicillin series, then today there are several of them, and therefore it is not difficult for doctors to choose the most suitable one for their patient.

Antibiotics for prostatitis are selected from the following drug groups.

from penicillins.

This group has a wide range of effects on bacteria and therefore it is most often prescribed precisely before data is received from the laboratory.

Used in the treatment of prostatitis Amoxiclav, Amoxicillin. Another advantage of these medicines is their budgetary price, and therefore every patient can receive treatment.

from macrolides.

This group includes Sumamed, Josamycin, Klacid, Rulid. Macrolides perfectly penetrate the tissues of the prostate gland and begin to fight infection after their first intake.

This group of drugs is practically non-toxic and does not affect the state of the intestinal microflora.

Cephalosparins.

They are mainly used in hospitals, as they are administered intramuscularly or intravenously.

Tetracyclines.

Effective for prostatitis caused by chlamydia. But these drugs are highly toxic and have a spermatotoxic effect. Therefore, before planning the conception, they are not prescribed.

Fluoroquinols.

They are used when there is no effect from drugs of other groups. These drugs include Ciprofloxacin, Levofloxacin.

When using antibiotics for the first time, it is necessary to record all changes in well-being. These drugs often cause severe allergic reactions, especially in patients with a history of allergies.

The antibiotic Amoxiclav belongs to the penicillin group and has a wide spectrum of action.

Due to this, Amoxiclav is often prescribed in the acute period of prostatitis even before the tests.

This medicine is not prescribed for severe violations of the functioning of the liver and for sensitivity to penicillins. It is used with caution in patients with renal pathologies.

When treating with Amoxiclav, it is important to always follow the dosage, since a slight excess of the dose can affect the appearance of dyspeptic disorders, increase anxiety and cause insomnia.

Usually, uncomplicated prostatitis with Amoxiclav is cured in a few days.

Roxithromycin is a macrolide. The components of the drug penetrate into the tissues of the prostate gland and accumulate in them, due to this, the therapeutic effect occurs quite quickly.

Roxithromycin is rapidly excreted from the intestine, but it is not prescribed for severe liver disease.

During the course of treatment, the simultaneous use of ergot alkaloids is excluded. Macrolides effectively fight mycoplasma, chlamydia, gonococci.

Doxycycline is prescribed at the beginning of the course of treatment, when the doctor assumes that the cause of the disease is a sexually transmitted infection.

Doxycycline successfully destroys chlamydia. The drug can cause changes in the gastrointestinal tract and therefore it is advised to take it during the daytime with plenty of water.

The drug is effective against a large group of gram-negative and gram-positive bacteria.

The therapeutic effect of Ceftriaxone develops rapidly. The drug is administered parenterally in a medical institution.

Carefully, the drug is used if the functioning of the liver and kidneys is impaired, if the patient has colitis and enteritis.

Compliance with the course of treatment with Ceftriaxone requires a complete rejection of alcohol. When the drug is administered, there is a risk of developing anaphylactic shock, so injections are given only in a hospital.

Lomefloxacin is a fluoroquinolone belonging to the group of essential medicines. The drug effectively treats prostatitis, as it has a wide spectrum of action and penetrates well into the tissues of the prostate gland.

Lomefloxacin should not be used for atherosclerosis, diseases of the central nervous system, including epilepsy.

When using this drug, coordination of movements is disturbed, therefore, at the time of treatment, it is worth refusing to drive vehicles and control complex devices and mechanisms.

The choice of antibiotic for the treatment of prostatitis must be entrusted to the doctor. Do not assume that the medicine that cured your neighbor will definitely help you.

The effectiveness of therapy is achieved by the right choice of treatment regimen. In order to achieve good results, the patient must follow the following rules:

The prescribed antibacterial course must be completed to the end;
During treatment, you can not reduce the dosage or change the time of admission, even if all acute signs of inflammation have passed;
In chronic prostatitis, antibiotic therapy can last several weeks and all treatment conditions must be observed to the end.

Antibiotics for prostatitis can cause changes in the intestinal microflora. Therefore, after using them, you need to drink probiotics, this will help the immune system recover faster.

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EVALUATION OF ARTICLE:

Chronic prostatitis (CP) is an advanced stage of the inflammatory process in the prostate. This is the most common male disease. Basically, the cause of chronic inflammation is an infection with the presence of bacteria.

Chronic prostatitis develops from infections

How is chronic inflammation different from acute inflammation?

The advanced stage of prostatitis differs from the acute process in its duration and development. During the acute period, a man develops pain, fever. These symptoms appear quickly enough, as well as disappear. With a chronic process, everything is more complicated and longer. Moreover, the signs of the disease may not show themselves or be practically unnoticed.

Chronic prostatitis is difficult to treat and constantly recurs.

In order to effectively treat chronic prostatitis, you first need to properly conduct examinations so as not to make a mistake with the prescription of drugs. The main thing is to correctly interpret the results of the tests, which will help the urologist in the selection of treatment.

CT may be required to make an accurate diagnosis.

As additional research, the patient will not hurt to consult a cardiologist, psychoneurologist, endocrinologist.

The urologist may also order a computed tomography (CT) scan. With its help, you can evaluate the structure of the brain, which during the illness is responsible for the severity of symptoms. Ultrasound of the prostate is a mandatory examination for suspected inflammation of the prostate.

The endocrinologist checks the condition of the thyroid gland, controls the hormonal background in a man.

The process of treating chronic prostatitis is not easy. This is difficult for both the urologist and the patient. Here it is important to cooperate with a specialist, follow his recommendations, take the prescribed drugs correctly. Modern treatment of prostatitis takes place with the use of antibiotics, massage, herbal medicine, physiotherapy, surgery. The prescribed schemes quite successfully cope with emerging relapses and help to delay their appearance for several years.

A course of antibiotics is prescribed to fight infections

Antibiotic therapy

Antibiotics are prescribed to clear the infection. Typically, a specialist considers drugs of the macrolide group, which includes oleandomycin and tetracycline. Other types of these drugs are also used, these are Kanamycin, Trimethoprim and Monomycin. The stage of treatment of any disease, however, like prostatitis, should be under the supervision of the attending physician. Only he can adequately and correctly prescribe a course of therapy and indicate its duration.

The duration of the course of treatment is approximately 14 days. After the treatment has been completed, the doctor prescribes tests for the patient, after which he evaluates the results and decides whether to change the treatment course or stop it.

This procedure improves secretion production, normalizes blood circulation in the prostate area. These well-established processes significantly improve the condition of a man.

In the absence of contraindications, massage is performed for treatment

Massage is not recommended for acute inflammation, the presence of hemorrhoids, microcracks in the rectum. Usually this procedure is combined with taking medications that can quickly suppress the infection. Their joint treatment process shows a fairly high efficiency in the treatment of chronic prostatitis.

The therapy improves prostate tissue, accelerates its healing. In the treatment of patients diagnosed with chronic prostatitis, transrectal hyperthermia, laser treatment, diadynamophoresis are used. If prostatitis occurs for a long time, the use of mud gives good results. Mineral and hydrogen sulfide waters are also used.

Goes as an addition to the main treatment. The most effective drug in this therapy is the "old man" from Bulgaria - Stamax. It contains extracts of palm fruits, which contain fatty acids that support the male reproductive system well. Side effects are practically not observed.

Stamax is also used in the treatment of prostatitis.

Surgery

Surgery for chronic prostatitis is needed if there is a narrowing of the urinary canal in a man. Also, surgery will be needed if there is such a pathology as adenoma or prostate abscess.

The first factors that provoke inflammation are viruses and infections. They pass to a man during sexual intimacy. Foreign bacteria destroy the urethral mucosa, then appearing in the tissues of the prostate. Therefore, chronic prostatitis is treated in several stages. For this, the correct schemes have been developed.

Treatment of bacterial prostatitis is a difficult task. Only in 30% of situations the patient gets rid of the permanent inflammatory process. Many men do not know how to treat inflammation. In the course of therapy, such moments are applied as:

taking anti-inflammatory drugs;
taking antidepressants to reduce anxiety in the face of pronounced symptoms;

Treatment may require antidepressants

"Targeted" therapy is also used, in which the drugs taken act on a specific area. A fluoroquinolone and antibiotics are commonly used. Surgery at an advanced stage of the disease is recommended if severe complications are observed.

Now the course of the treatment regimen is justified, but only if it is correctly observed. Its duration is 2 weeks, after which tests are taken to assess the dynamics of the state of the prostate. Usually, after a two-week course, a positive trend is observed.

Antibiotics used in the treatment of chronic prostatitis successfully cope with the destruction of infections, pathogenic bacteria. A good urologist always prescribes drugs of this group for chronic inflammation. This is the first medicine included in the treatment course.

For effective treatment, it is important to take medications in a timely manner.

With this disease, it is important to follow the treatment regimen, adhere to the medication schedule.

There is no miracle pill for chronic prostatitis. A cure to the very end is possible if the patient is attentive to his health, adheres to the advice of a doctor, takes medications correctly, and leads a healthy lifestyle. A thorough diagnosis of the pelvic organs is also important.

Self-medication is a deliberate harm to one's health, since chronic prostatitis is a rather specific disease, often causing complications.

To expand your knowledge of chronic prostatitis and its treatment, watch the following video:

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

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

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

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

I (NIH category I): acute prostatitis - acute infection of the pancreas;

II (NIH category II): CKD is a chronic infection of the pancreas characterized by recurrent urinary tract infection;

III (NIH category III): chronic prostatitis/chronic pelvic pain syndrome - symptoms of discomfort or pain in the pelvic area for at least 3 months. in the absence of uropathogenic bacteria detected by standard cultural methods;

IIIA: inflammatory syndrome of chronic pelvic pain (abacterial prostatitis);

IIIB: non-inflammatory syndrome of chronic pelvic pain (prostatodynia);

IV (NIH category IV): asymptomatic prostatitis found in men being examined for another disease in the absence of symptoms of prostatitis.

Acute bacterial

prostatitis (OPP)

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

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

Chronic bacterial

prostatitis (CKD)

CKD is the most common urological disease among men aged 25 to 55 years, is a non-specific inflammation of the pancreas. Chronic nonspecific prostatitis occurs in approximately 20-30% of young and middle-aged men and is often accompanied by impaired copulatory and fertility functions. Complaints characteristic of chronic prostatitis disturb 20% of men aged 20 to 50 years, but only two-thirds of them seek medical help.

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

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

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

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

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

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

Chronic prostatitis/syndrome

chronic pelvic pain (CP/CPPS)

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

1. The presence of an infectious agent. DNA-containing bacterial pathogens are often found in the secretion of the prostate during examination of patients, which may indirectly indicate their pathogenicity in relation to the pancreas. The ability to restore the DNA structure of some pathogens, in particular Escherichia coli, other bacteria of the genus Enterococcus, allows microorganisms to exist for a long time in a latent state, without showing themselves. This is evidenced by the data of cultural studies. After antibiotic therapy, bacterial cultures of prostate secretion are negative. But after some time, bacteria capable of restoring their own DNA structure appear again in culture crops.

2. Violation of the function of regulation of the detrusor. The severity of dysuric phenomena may vary in different patients. HP may be completely asymptomatic. However, ultrasound data confirm the appearance of residual urine in patients with CP. This contributes to excessive stimulation of pain neuroreceptors and the appearance of a feeling of incomplete emptying of the bladder.

3. Reduced immunity. Conducted immunological studies in patients with CPP showed significant changes in the immunogram. The number of inflammatory cytokines statistically increased in most patients. At the same time, the level of anti-inflammatory cytokines was reduced, which confirmed the appearance of an autoimmune process.

4. The appearance of interstitial cystitis. Schaeffer A.J., Anderson R.U., Krieger J.N. (2006) showed an increase in the sensitivity of the potassium intravesicular test in patients with CP. But the data obtained are currently being discussed - the possibility of an isolated appearance of CP and interstitial cystitis is not ruled out.

5. Neurogenic factor in the appearance of unbearable pain. Clinical and experimental data have confirmed the source of pelvic pain, the main role in the origin of which is played by the spinal ganglia, which respond to inflammatory changes in the pancreas.

6. The appearance of venous stasis and lymphostasis in the pelvic organs. In patients with the presence of a hypodynamic factor, stagnation occurs in the pelvic organs. At the same time, venous congestion is noted. A pathogenetic relationship between the development of CP and hemorrhoids has been confirmed. The combination of these diseases occurs quite often, which confirms the general pathogenetic mechanism of the onset of diseases, based on the appearance of venous stasis. Lymphostasis in the pelvic organs also contributes to the violation of the outflow of lymph from the pancreas, and with a combination of other negative factors leads to the development of the disease.

7. Influence of alcohol. The impact of alcohol on the reproductive tract not only causes negative consequences for spermatogenesis, but also exacerbates chronic inflammatory diseases, including prostatitis.

Asymptomatic

chronic prostatitis (BCP)

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

Material and research methods

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

results

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

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

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

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

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

Conclusion

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

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

Literature

1. Pushkar D.Yu., Segal A.S. Chronic abacterial prostatitis: modern understanding of the problem // Medical class. - 2004. - No. 5–6. – P. 9–11.

2. Drusano G.L., Preston S.L., Van Guilder M., North D., Gombert M., Oefelein M., Boccumini L., Weisinger B., Corrado M., Kahn J. A population pharmacokinetic analysis of the penetration of the prostate by levofloxacin. Antimicrobial Agents Chemother. 2000 Aug;44(8):2046-51

3. Garcia-Castillo M., Morosini M.I., Galvez M., Baquero F., del Campo R., Meseguer M.A. Differences in biofilm development and antibiotic susceptibility among clinical Ureaplasma urealyticum and Ureaplasma parvum isolates. J Antimicrob Chemother. 2008 Nov;62(5):1027-30.

4. Schaeffer A.J., Anderson R.U., Krieger J.N. The assessment and management of male pelvic pain syndrome, including prostatitis. In: McConnell J, Abrams P, Denis L, et al., editors. Male Lower Uninary Tract Dysfunction, Evaluation and Management; 6th International Consultation on New Developments in Prostate Cancer and Prostate Disease. Paris: Health Publications; 2006.pp. 341–385.

5. Wagenlehner F. M. E., Naber K. G., Bschleipfer T., Brahler E.,. Weidner W. Prostatitis and Male Pelvic Pain Syndrome Diagnosis and Treatment. Dtsch Arztebl Int. March 2009; 106(11): 175–183

6. Nickel J.C., Downey J., Feliciano A.E. Jr., Hennenfent B. Repetitive prostatic massage therapy for chronic refractory prostatitis: the Philippine experience. Tech Urol. 1999 Sep;5(3):146-51

7. Nickel J.C., Downey J., Clark J., Ceri H., Olson M. Antibiotic pharmacokinetics in the inflamed prostate. J Urol. 1995 Feb;153(2):527-9

8. Nickel J.C., Olson M.E., Costerton J.W. Rat model of experimental bacterial prostatitis. infection. 1991;19(Suppl 3):126–130.

9. Nelson W.G., DeMarzo A.M., DeWeese T.L., Isaacs W.B. The role of inflammation in the pathogenesis of prostate cancer. J Urol. 2004;172:6–11.

10. Weidner W., Wagenlehner F.M., Marconi M., Pilatz A., Pantke K.H., Diemer T. Acute bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: andrological implications. Andrologia. 2008;40(2):105–112.

The disease can occur in acute (as a rule, occurs from 30 to 50 years old) and chronic form.

The main symptoms of prostatitis are:

not sharp, aching, pulling pains in the perineum, radiating to the rectum, testicles, glans penis, sacrum, rarely to the lower back;
dysuric disorders, especially in the morning, a constant feeling of incomplete emptying of the bladder;
loose secretion after urination;
increased pain during a long stay in a sitting position and their decrease after walking;
erectile disorders, premature ejaculation, impotence;
violation of the general condition, nervousness, decreased performance, insomnia.

Fluoroquinolones are the "gold standard" of treatment.

Ciprofloxacin has no effect on ureaplasma, treponema and Clostridium difficile.

Antibiotic is contraindicated:

up to eighteen years of age;
in the presence of colitis caused by taking antimicrobial agents in history;
in case of individual hypersensitivity to fluoroquinolones;
patients with porphyria, severe renal and hepatic insufficiency;
simultaneously with Tizanidin;
epileptics and persons with severe lesions of the central nervous system;
in violation of cerebral circulation;
in patients with tendon injury associated with fluoroquinolones.

To reduce the risk of adverse events, it is recommended for the duration of therapy:

exclude physical activity and excessive insolation;
use creams with high SPF;
increase drinking regimen.

Ciprofloxacin is not combined with non-steroidal anti-inflammatory drugs, due to the high risk of seizures. It is also able to enhance the toxic effect on the kidneys of Cyclosporine.

When combined with Tizanidine, a sharp drop in blood pressure is possible, up to collapse.

Use during anticoagulant therapy may cause bleeding. Enhances the effect of hypoglycemic tablets, increasing the risk of hypoglycemia.

When combined with glucocorticosteroids, the toxic effect of fluoroquinolones on tendons increases.

In combination with beta-lactams, aminoglycosides, metronidazole and clindamycin, a synergistic interaction is observed.

Calculation of the dose and duration of treatment

500 to 750 milligrams twice a day. When using drugs with prolonged action (Cifran OD 1000 mg), a single dose is possible. The maximum dose per day is 1.5 grams.

In a severe form of the disease, therapy begins with intravenous administration, with a further transition to oral administration.

The duration of treatment depends on the severity of the disease and the presence of complications. The standard course of therapy is from ten to 28 days.

To eradicate the pathogen and eliminate the inflammatory process, broad-spectrum drugs are used that work against the most common pathogens.

I) Fluoroquinolones:

Norfloxacin (Nolitsin, Norbaktin);
Ciprofloxacin (Tsiprolet, Tsiprobay, Cifran OD, Tsiprinol, Quintor, Quipro);
Levofloxcin (Tavanik, Glevo, Levolet R);
Ofloxacin (Tarivid, Zanonin OD);
Moxifloxacin (Avelox).

II) Fluoroquinolones in combination (the best antibiotics for prostatitis caused by mixed infection):

Ofloxacin + Ornidazole (Ofor, Polymic, Combiflox);
Ciprofloxacin + Tinidazole (Cifran ST, Tsiprolet A, Tsiprotin, Zoxan TZ);
Ciprofloxacin + Ornidazole (Orcipol).

III) Cephalosporins:

Cefaklor (Vercef);
Cefuroxime-axetil (Zinnat);
Cefotaxime (Cefabol);
Ceftriaxone (Rofecin);
Cefoperazone (Medocef, Cefobit);
Ceftazidime (Fortum);
Cefoperazone / sulbactam (Sulperazone, Sulzoncef, Bakperazone, Sulcef);
Cefixime (Supraks, Sorcef);
Ceftibuten (Cedex).

IV) Inhibitor-protected penicillins (Axicillin/Clavulanic acid):

Augmentin;
Amoxiclav;
ranclave;
Panklav.

V) Macrolides:

Clarithromycin (Criksan, Fromilid, Klacid);
Azithromycin (Azivok, Azitrocin, Zimaks, Zitrolit, AzitRus, Sumamed forte);
Roxithromycin (Roxide, Rulid).

VI) Tetracyclines(doxycycline):

Unidox Solutab;
Apo-Doxy;
Vibramycin D.

VII) Sulfonamides(Sulfamethoxazole/Trimethoprim):

Biseptol;
Bactrim.

The drug has a wide spectrum of bactericidal activity due to irreversible binding to the 50S subunits of bacterial ribosomes and inhibition of the processes of synthesis of structural components of the microbial wall. When high therapeutic concentrations are reached in the focus of inflammation, the antibiotic begins to act bactericidal.

Azithromycin (active substance) is prescribed only in the early stages, with a mild course of the disease, or if there are contraindications to other antibiotics.

Sumamed is effective against methicillin-sensitive strains of staphylococcus, penicillin-sensitive strains of streptococcus, gram-negative aerobes, chlamydia, mycoplasma.

Methicillin-resistant staphylococci, penicillin-resistant streptococci, enterococci, erythromycin-resistant gram-positive microbes are resistant to the action of Azithromycin.

Sumamed should be taken one hour before or two hours after eating.

With a five-day course, the dose of antibiotic on the first day is one gram. Then appoint 500 milligrams for four days.

With a three-day treatment, one gram of Sumamed is indicated for three days.

The drug is not prescribed:

persons with individual hypersensitivity to macrolides;
severe diseases of the kidneys and liver;
against the background of the use of ergotamine and dihydroergotamine;
with severe arrhythmias.

It is used with caution in patients with myasthenia gravis, heart failure, hypokalemia and hypomagnesemia, impaired renal and hepatic function of mild to moderate severity.

Alcohol, food and antacids reduce the bioavailability of Sumamed. Not recommended for persons receiving anticoagulants. Poorly combined with oral hypoglycemic agents, there is a risk of hypoglycemia. Shows antagonistic interaction with Lincosamides and synergistic with Chloramphenicol and Tetracycline. Has a farm. heparin incompatibility.

Biseptol

This is a combined agent from the group of sulfonamides containing sulfamethoxazole and trimethoprim. Biseptol shows a pronounced bactericidal activity and has a wide spectrum of action.

Sulfamethoxazode has a structural similarity to para-aminobenzoic acid, due to which it inhibits the synthesis of dihydrofolic acid. This mechanism is enhanced by the action of Trimethoprim, which disrupts protein metabolism and division processes in the microbial cell.

The combined composition ensures the effectiveness of Biseptol even against bacteria that are resistant to sulfonamides. Not active against mycobacteria, Pseudomonas aeruginosa and spirochetes.

Biseptol is contraindicated in:

the presence of structural changes in the liver parenchyma;
severe renal failure with creatinine clearance less than 15 ml/minute;
blood diseases (aplastic, megaloblastic, B12 and folic acid deficiency anemia, agranulocytosis and leukopenia);
elevated levels of bilirubin;
deficiency of glucose-6-phosphate dehydrogenase
bronchial asthma;
thyroid diseases;
individual intolerance to the components of the drug.

Undesirable effects from the application:

disorders of the gastrointestinal tract;
decrease in the number of leukocytes, platelets, granulocytes;
peripheral neuropathies;
headaches, dizziness, confusion;
diarrhea and pseudomembranous colitis;
aseptic meningitis;
bronchospasm;
dysfunction of the liver;
interstitial nephritis and toxic nephropathy;
allergic manifestations;
hypoglycemic conditions;
photosensitivity.

For the treatment of prostatitis, an antibiotic is prescribed 4 tablets at a dosage of 480 milligrams per day.

In severe cases of the disease, the dosage can be increased to six tablets. Biseptol is recommended to be consumed twice a day, after meals, with plenty of chilled boiled water. The course of therapy is 10 or more days, depending on the severity of the treatment.

During the use of Biseptol, it is necessary to increase the drinking regimen and exclude cabbage, spinach, carrots and tomatoes from the diet. When conducting long-term therapy or in the case of using the drug in the elderly, an additional appointment of folic acid is recommended.

If it is necessary to conduct long-term antimicrobial therapy, the appointment of an oral solution of Itraconazole is indicated, at the rate of 400 milligrams per day for seven days.

The use of Tamsulosin is highly effective.

It is a specific blocker of alpha1-adrenergic receptors of the smooth muscles of the prostate gland. The action of the drug leads to a decrease in muscle tone (reducing congestion) and an improvement in urine outflow.

Organotropic preparations have also proven themselves well. The most commonly used is Prostacol. This is a polypeptide agent of animal origin, which has a tropism for human prostate tissues. Prostacol reduces the severity of edema, eliminates pain and discomfort, reduces the inflammatory response and increases the functional activity of the gland's own cells. Also, it reduces platelet aggregation, acting as a prevention of thrombosis of the pelvic vessels.

As an additional treatment in order to accelerate recovery, increase the body's resistance to bacteria and reduce the severity of the inflammatory reaction, immunotherapy (Timalin) is prescribed.

To eliminate congestion and restore the functions of the prostate gland, prostate massage and pelvic floor muscle training are used.

Warm sitz baths with decoctions of chamomile or sage and the addition of 1-2% novocaine are also effective.

In order to answer the question: what antibiotics are used to treat bacterial prostatitis, it is necessary to determine the spectrum of the main pathogens and the ways of infection.

The most common cause of the inflammatory process are: Escherichia and Pseudomonas aeruginosa, staphylo- and enterococci, Klebsiella, Proteus, less often chlamydia and ureaplasma.

In the vast majority of cases, a mixed (mixed) infection associated with both anaerobic and aerobic pathogens is isolated from the prostate secretion obtained after massage. The most common component of such microbial associations are staphylococci.

The combination of pathogens complicates the treatment process and leads to a mutual enhancement of the inflammatory properties and drug resistance of the pathogenic flora.

That is why, in such a situation, it is preferable to use a combined antibacterial treatment.

Also, it is important to consider the ways of infection of the gland:

hematogenous (in the presence of a distant purulent-septic focus);
lymphogenous (infection from the rectum);
canalicular (penetration of infection from the back of the urethra).

The article was prepared by an infectious disease doctor
Chernenko A. L.

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

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

Chronic bacterial prostatitis (CKD)

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

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

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

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

Asymptomatic chronic prostatitis (BCP)

Material and research methods

results

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

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

Conclusion

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

Literature

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

Prostatitis is an inflammation of the prostate tissue. The prostate gland is an organ in the male body that produces the prostate secretion, which is an integral part of the sperm, and also plays the role of a valve that closes the exit from the bladder during an erection. In addition, the prostate contributes to the production of testosterone, which is responsible for masculinity.

Classification

Prostatitis is usually divided into acute and chronic, as well as infectious (bacterial) and non-infectious (abacterial).

The causes of this disease are as follows:

STIs, that is, sexually transmitted infections (ureaplasma, chlamydia, gonococcus, Candida fungus, etc.) are able to penetrate into the tissues of the urethra and damage them.
Impaired circulation in the pelvis. Stagnation, which is observed in the prostate, will lead to the fact that it becomes inflamed.
Sedentary lifestyle. At risk are office workers, drivers and officials.
Impaired immunity.
Regular stress.
Hormonal imbalance.
Lack of trace elements and vitamins in the body.
Regular hypothermia.

It cannot be said that if you have frequent stress or you are bus drivers, then you will have 100% prostatitis. However, we can say that you are at risk, and you should carefully monitor your health.

Treatment of prostatitis

As we can see, there are quite a few reasons why prostatitis develops, and almost all of them are somehow caused by various microorganisms (viruses, bacteria, fungi and protozoa).

When we begin to treat prostatitis, we face two very important tasks: to destroy the pathogen and remove inflammation.

It is worth noting that there are quite a few methods to relieve inflammation, ranging from medical procedures to folk remedies. However, in order to overcome the pathogen, only antibiotics can help us, which, by the way, cannot always cope on their own.

This is due to the fact that antibiotics can affect bacteria and protozoa, while the same viruses have complete resistance to them, and there is a special antifungal therapy against fungi.

How to treat prostatitis with antibiotics

Today, there are a huge number of antibacterial drugs and antibiotic treatment regimens for prostatitis, as well as a huge number. However, it must be remembered that for successful treatment it is best to determine the type of pathogen. You can also use broad-spectrum antibiotics, but their effectiveness is much lower than that of antibiotics that are tailored for a specific pathogen.

To determine the type of pathogen, a special analysis is carried out. It requires only prostate juice. In addition, another analysis is carried out in order to test the sensitivity of a particular pathogen to a number of antibiotics. These analyzes will greatly facilitate treatment in the future. And that is why good doctors do not immediately prescribe drugs to the patient, but prefer to wait for the test results first.

Briefly about the forms of the disease

The choice of the drug will depend entirely on what form of prostatitis, at what stage it is and what is the general condition of the patient.

There are 2 forms of the disease:

Acute. The symptoms are well expressed. The patient is concerned about the incessant itching in the inguinal region, urination in fractional portions, painful and difficult. Quite often, this can be accompanied by a high temperature. If you consult a doctor in a timely manner and undergo a course of treatment, then the prognosis is a complete recovery.
Chronic. The disease is recurrent. Periods of exacerbation are followed by periods of remission. Occurs in situations where acute prostatitis was not treated or its treatment was incorrect. As a rule, it proceeds very hard and the prognosis is very unfavorable, up to prostate adenoma or prostate cancer.

Treatment of the acute stage of prostatitis takes only 3-5 weeks. As for the chronic stage, everything is much slower here. The effect of the treatment may be noticeable only after a few weeks, and recovery may take up to six months.

How to choose a drug

Antibiotics have different ability to penetrate through the membrane of any organ and accumulate in this organ in order to achieve an effective concentration. That is why, before starting treatment, it is so important to first analyze the sensitivity of a particular pathogen to antibiotics, and only then proceed to treatment. Nowadays, the indiscriminate use of antibiotics leads to the fact that microorganisms develop resistance to drugs faster than pharmaceutical companies produce them. In the end, we may end up with a situation where we simply do not have antibiotics left.

Read also: How long is prostatitis treated

Because of this, competent specialists prefer to wait for the results of the analysis, and only then prescribe the necessary drug. If the drug is prescribed earlier and not the one that is needed, then this will not improve the body in any way, but the microorganism will begin to develop resistance to this drug. And although in this situation it is not so critical, because the bacterium will not be able to spread particularly, but even in such a situation, this should not be forgotten.

Important nuances

During the treatment of bacterial prostatitis with antibiotics, alcohol should be completely excluded from your diet. Even small doses of alcohol, in the form of a glass with dinner, can weaken the effect of antibiotics, as well as worsen your general condition.

Another important nuance is the fact that all strong antibiotics have a spermatotoxic effect. Therefore, after the end of taking antibiotics and before the date of conception, about 5-6 months should pass.

In addition, during antibiotic treatment, you should try to carry out other measures that will help improve the functioning of the prostate gland. Massage procedures, various medical procedures and, of course, taking vitamins are well suited.

Groups of antibiotics

It should be remembered that what is written below is written for informational purposes only. In no case should you independently diagnose prostatitis in yourself or your friends and treat it without consulting a specialist.

There are 6 main groups of antibiotics that can help a person beat prostatitis

Penicillins

Amoxicillin and Amoxiclav. Doctors like to use this group of antibiotics due to the fact that their action is well studied. Amoxiclav is available in powder form, tablet form or oral suspension form. A single dose is 250 or 500 mg, the daily dose should not exceed 2 g. The drug is recommended to be divided into 3-4 doses. Amoxicillin is mainly used in tablet form. A single dose is 500-1000 mg, the daily dose should not exceed 3 g. The drug is also divided into 3-4 times.

Tetracyclines

doxycycline and tetracycline. Antibiotics of this series are prescribed, as a rule, for prostatitis, which was caused by chlamydia or mycoplasma. The release form of tetracycline is tableted. A single dose is 250 mg. The daily allowance does not exceed 1 g. The drug intake should be divided into 4 times a day. Doxycycline also comes in tablet form. The single dose is 100 mg. The daily dose does not exceed 200 mg. It is necessary to take 2 times a day.

Cephalosparins

Ceftriaxone and Cefuroxime - these antibiotics have a wide spectrum of action. Ceftriaxone and Cefuroxime are able to fight anaerobic infections, as well as both Gram + and Gram bacteria (Proteus, Staphylococcus, Streptococcus and Haemophilus influenzae). Ceftriaxone is administered exclusively parenterally, that is, intravenously or intramuscularly. There is no tablet form. A single and daily dose ranges from 1 to 2 g. This is due to the fact that the drug is administered only 1 time per day. The route of administration of cefuroxime is the same as that of ceftriaxone. A single dose is from 750 to 1500 mg, and a daily dose is from 2 to 6 g. It is taken 3 times a day.

Fluoroquinolones

Ofloxacin and Ciprofloxacin - have a wide spectrum of action. They are not drugs of choice. Their main feature is that they penetrate well into the tissue of the prostate gland and accumulate there. They are used in the detection of many gram + and gram bacteria, as well as chlamydia, mycoplasma gardnerella and ureaplasma. Ofloxacin is produced exclusively in capsules. Capsules come in 200 and 400 mg. It is taken 1 time per day. Ciprofloxacin is available in tablet form, but is more commonly used as an injection. A single dose is 200 or 400 mg. Daily can reach 800 mg. Taking the drug - 2 times a day.