Chronic Prostatitis: Treatment Update
Chronic Prostatitis Treatment Evolution at Prostate Institute of America
Antibiotics are the most important and main component in my medication treatment mixture. Infections caused by gram negative bacteria is the most common cause of bacterial prostatitis/urinary tract infection. As a result, I have used Fluoroquinolone and Gentamicin as the main antibiotic modalities for a long period of time with variable clinical success.
It became apparent that most of my patients have been exposed to Fluoroquinolones for extended period of time before they came to get treatment here. Easy access, oral formulary, and broad-spectrum coverage have led to widespread and improper use of Fluoroquinolones. Subsequently, resistance against Fluoroquinolones have developed worldwide.
About a year ago, I replaced Fluoroquinolone (Levofloxacin) with Cephalosporin (Ceftriaxone) in my treatment mixutre. Ceftriaxone is a broad-spectrum antibiotic, and has less chance of overuse and improper use since it can be administered only intramuscularly or intravenously. It is my personal experience to notice slightly better response clinically.
However, recent publications have reported increased prevalence of bacteria that contain enzymes known as extended-spectrum beta-lactamase (ESBL) that confer resistance to most antibiotics, particularly antibiotics from the penicillin, cephalosporin, and monobactam families. Furthermore, ESBL organisms often exhibit concurrent resistance against Fluoroquinolones and Cotrimoxazoles (Bactrim). Infections with ESBL-producing organisms have been associated with poor outcome.
ESBLs have been found exclusively in gram-negative organisms, particularly Escherichia coli and Klebsiella, but also in Acinetobacter, Enterobacter, Proteus, Pseudomonas, Salmonella, and Shigella.
Community and hospital-acquired ESBL-producing gram negative bacteria are prevalent worldwide. Antibiotics from the Carbapenem family are the best anti-microbial agents to treat infections caused by such organisms.
Based on these updated information and my experience, I have revised my treatment cocktail. It is now consisted of a mixture of Carbapenem antibiotic, Aminoglycoside antibiotic, anti-anaerobe/anti-protozoa antibiotic, and anti-fungal agents. Corticosteroid is also added to the mixture in case the underlying etiology is an auto-immune reaction. The treatment mixture also contains Lidocaine and Ketorolac for pain control.
This medication treatment mixture is directly infiltrated into the prostate and seminal vesicles under precise transrectal ultrasound guidance.
Revised November, 2013