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The role of quinolones in the treatment of chronic bacterial prostatitis

Die Rolle der Chinolone bei der Behandlung der chronisch bakteriellen Prostatitis

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Summary

Chronic bacterial prostatitis is a rare infection but difficult to treat. Usually co-trimoxazole has been used, yet with poor results. Because of their favorable pharmacokinetics and their broad antibacterial spectrum, the newer quinolones may be a good alternative. In contrast to ß-lactam antibiotics their concentrations in prostatic fluid, in prostatic tissue and in seminal fluid are relatively high in comparison to the corresponding plasma concentrations. For prostatic fluid measurements, however, possible urinary contamination has to be considered and identified otherwise falsely high levels are measured. A total of 23 studies with the newer quinolones (norfloxacin, ciprofloxacin, ofloxacin, pefloxacin, enoxacin, temafloxacin and rufloxacin) in the treatment of chronic bacterial prostatitis are available. However, the results of these studies are difficult to compare because not all investigators used the same diagnostic criteria and there was a considerable range of duration of treatment and of follow-up. Since the issue involved in the treatment of prostatitis is that of relapse, patients cannot be considered cured if they have been followed for one week or one month only. There were four studies among the 23 publications, i.e. one with norfloxacin and three with ciprofloxacin, which fulfilled the criteria of standardized prostatic localization and of long-term follow-up of at least six months. The results are promising, but further investigations, especially controlled studies, are needed in order to determine the role of the newer quinolones in the treatment of chronic bacterial prostatitis.

Zusammenfassung

Die chronisch bakterielle Prostatitis ist eine seltene, aber schwer zu behandelnde Infektion. Gewöhnlich wurde Co-trimoxazol verwendet, wenn auch mit schlechten Therapieergebnissen. Wegen der günstigen pharmakokinetischen Eigenschaften und des breiten antibakteriellen Spektrums könnten die neureren Chinolone eine gute Alternative sein. Im Gegensatz zu den ß-Lactam-Antibiotika verfügen sie im Vergleich zu den Plasmakonzentrationen über relativ hohe Konzentrationen im Prostatasekret, im Prostatagewebe und in der Samenflüssigkeit. Bei der Bestimmung der Prostatasekretkonzentrationen müssen jedoch Urinkontaminationen sorgfältig ausgeschlossen werden, um nicht fälschlich hohe Konzentrationen zu erhalten. Insgesamt wurden 23 Studien analysiert, in denen neuere Chinolone (Norfloxacin, Ciprofloxacin, Ofloxacin, Pefloxacin, Enoxacin, Temafloxacin und Rufloxacin) zur Therapie der chronisch bakteriellen Prostatitis verwendet wurden. Die Ergebnisse sind jedoch schwer vergleichbar, da nicht alle Autoren dieselben diagnostischen Kriterien verwendeten und es auch eine erhebliche Schwankungsbreite in der Therapiedauer und Nachbeobachtungszeit gab. Da bei der Behandlung der Prostatitis die Rezidivrate eine besondere Bedeutung hat, kann man Patienten, die lediglich eine Woche oder ein Monat nach Therapieabschluß beobachtet wurden, noch nicht als geheilt betrachten. Nur vier Studien, eine mit Norfloxacin und drei mit Ciprofloxacin, erfüllten die Kriterien der Standarddiagnostik, mit der die Infektion auf die Prostata lokalisiert werden kann, und der ausreichend langen Beobachtungszeit von mindestens sechs Monaten nach Therapieabschluß. Die Ergebnisse sind ermutigend, aber weitere Untersuchungen, insbesondere kontrollierte Studien, sind erforderlich, um die Rolle der neueren Chinolone bei der Behandlung der chronisch bakteriellen Prostatitis bestimmen zu können.

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Naber, K.G. The role of quinolones in the treatment of chronic bacterial prostatitis. Infection 19 (Suppl 3), S170–S177 (1991). https://doi.org/10.1007/BF01643692

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