In 1999, the National Institutes of Health redefined prostatitis into four distinct entities: acute bacterial prostatitis, chronic bacterial prostatitis, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and asymptomatic inflammatory prostatitis.
Dr. Kurt Naber states in the "Journal Antimicrobial Chemotherapy" that up to 50 percent of men suffer from prostatitis at some point in their lives and it negatively affects their quality of life. Eighty percent of patients with chronic bacterial prostatitis have recurrent episodes of urinary tract infection due to E. coli. Other bacteria responsible for UTIs include Klebsiella spp, Pseudomonas aeruginosa, and Proteus spp. Between symptomatic episodes, urinary tract cultures can document an infected prostate gland. "Harrison's Principles of Internal Medicine" states that the challenge in curing chronic prostatitis arises because most antibiotics do not penetrate the capillaries around the prostate.
Fluoroquinolones
Fluroquinolones penetrate well into prostatic tissue. As stated by Dr. C. Oliphant in the journal "American Family Physician" when taken for four to six weeks, norfloxacin, ciprofloxacin, levofloxacin and ofloxacin have eradication rates of 67 to 91 percent. They are more efficacious if prescribed soon after symptoms begin. These cure rates make fluroroquinolones the drugs of choice for treating chronic bacterial prostatitis.
According to the "Washington Manual of Medical Therapeutics," patients with chronic bacterial prostatitis should receive prolonged antibiotic therapy for at least one month with fluroquinolones. Relapses occur with shorter courses, e.g., two weeks.
TMP/SMX
Trimethoprim sulfamethoxazole, or TMP/SMX, another option for treating chronic prostatitis provides cure rates of greater than 50 percent of chronic prostatitis cases, as stated by Dr. Kurt Naber in the "Journal Antimicrobial Chemotherapy."
Macrolides
The macrolides, azithromycin and clarithromycin, also penetrate the prostate well. These drugs were used successfully in men with chronic prostatitis in small clinical studies conducted by Dr. V. Skerk in 2002 to 2004, but never in a randomized controlled trial.
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