Treating Prostatitis Effectively: A Challenge For Clinicians
Nhuan Nguyen, PharmD, MBA, CHEClinical PharmacistGR Health, Georgia Regents Medical CenterAugusta, GeorgiaCharlie Norwood VA Medical CenterAugusta, GeorgiaUniversity of Georgia College of PharmacyAthens, Georgia
US Pharm. 2014 39:35-40.
ABSTRACT: Prostatitis, which affects 5% to 9% of males and occurs mostly in middle age, is classified based on signs and symptoms, with urinary urgency, frequency, and pain typical in nearly all categories. Most physicians are not familiar with prostatitis, particularly chronic prostatitis associated with chronic pelvic pain syndrome . Accordingly, patients are often misdiagnosed and receive ineffective treatment, resulting in poor quality of life. CP/CPPS is challenging to treat, as its causes are not clearly defined and the antibiotics used for therapy have low effective rates. Clinical pharmacists can contribute significantly to patient care by advising physicians and other medical professionals regarding drug efficacy, adverse drug reactions, and drug interactions, and by assisting in the selection of optimal antibiotics and/or treatment regimens for prostatitis.
Prostatitis , which occurs in 5% to 9% of males aged 18 years and older, most often develops in middle age.1 In the early 1990s, prostatitis accounted for about 1% and 8% of office visits to family practitioners and urologists, respectively.1
Infection By Germs That Normally Live In Your Bowel
This is the usual cause. Some bacteria that live harmlessly in the bowel commonly get on to the skin near to the anus when we pass stools . In some people they may then multiply. Some of these bacteria may then travel up the urethra and cause infection anywhere in the urinary tract that is, the kidneys, bladder, prostate, or urethra. This is called a urinary tract infection.
A prostate infection may also occur with or without other parts of the urinary tract being infected. Some conditions that cause pooling or blockage of urine increase the risk of a urinary tract infection. For example, having an enlarged prostate or kidney stones. This is because bacteria often thrive and multiply quickly in pooled urine.
What Is The Treatment For Acute Prostatitis
- Antibiotics. A four-week course is needed. Antibiotics are generally started before the confirmatory urine test results are back. The first antibiotic may be changed after the result of the urine test is back. The urine test finds exactly which germ is causing the infection and the best antibiotic to treat it. Four weeks of antibiotics are thought to be necessary to reduce the chance that you develop persistent prostatitis. If you are very unwell, you may need to go into hospital to have the antibiotics given through a vein..
- Paracetamol or ibuprofen ease pain and high temperature . They are best taken regularly rather than now and then. Stronger painkillers are sometimes needed.
- Laxatives can keep your stools soft, if needed. They may help to ease pain if you have hard stools in your back passage , pressing on your infected prostate.
Read Also: How To Restore Gut Bacteria After Antibiotics
You May Like: Antibiotics For Lyme Disease In Dogs
When To Get Medical Advice
See a GP if you have symptoms of prostatitis, such as pelvic pain, difficulty or pain when peeing, or painful ejaculation.
Theyll ask about the problems youre having and examine your tummy.
You may also have a rectal examination. This is where a doctor inserts a gloved finger into your bottom to feel for anything unusual. You may have some discomfort during this examination if your prostate is swollen or tender.
Your urine will usually be tested for signs of infection, and you may be referred to a specialist for further tests to rule out other conditions.
See a GP straight away if you get sudden and severe symptoms of prostatitis.
You may have acute prostatitis, which needs to be assessed and treated quickly because it can cause serious problems, such as suddenly being unable to pee.
If you have persistent symptoms , you may be referred to a doctor who specialises in urinary problems .
Recommendations For A General Approach
Although evidence to support them is scarce, the following recommendations are offered. If the history and physical examination suggest prostatitis, physicians may consider a diagnostic test, such as the four-glass test or the PPMT. In most cases, empiric antibiotic therapy is reasonable whether or not the diagnostic test proves a bacterial cause. Common choices include TMP-SMX, doxycycline or one of the fluoroquinolones. Treatment is often recommended for four weeks, although some clinicians use shorter courses. Physicians should encourage hydration, treat pain appropriately and consider the use of NSAIDs, an alpha-blocking agent, or both. If symptoms persist, a more thorough evaluation for CNP/CPPS should be pursued. Some patients may need several trials of different therapies to find one that alleviates their symptoms.
The term prostatitis describes a wide spectrum of conditions with variable etiologies, prognoses and treatments. Unfortunately, these conditions have not been well studied, and most recommendations for treatment, including those given here, are based primarily on case series and anecdotal experience. For these reasons, many men and their physicians find prostatitis to be a challenging condition to treat.
Recommended Reading: Can I Smoke Weed While Taking Antibiotics
Chronic Prostatitis Treatment Evolution At The Prostate Institute Of America
Antibiotics are the most important and main component in my medication treatment mixture. Infection 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 antibiotics for a long period of time with variable clinical success.
It has become apparent that most of my patients have been exposed to Fluoroquinolones for extended periods of time before they come to get the treatment here. Easy access, oral formulary availability, and broad-spectrum coverage have led to widespread and improper use of Fluoroquinolones. Subsequently, resistance against Fluoroquinolones have developed worldwide.
A few years ago, I replaced Fluoroquinolone with Cephalosporin in the treatment mixture. Ceftriaxone is a broad-spectrum antibiotic, and has less chance of overuse and improper use since it can only be administered only intramuscularly or intravenously. In my personal experience I have noticed slightly better results clinically.
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.
Avelox Prescribed For :
Avelox Antibiotic is Prescribed by a Physician For The following Conditions Such as :ï¬ Bacterial Infections
ï¬ Sleeping Difficulties
Does Avelox can Cure Prostatitis ?The Avelox is Prescribed to Patients Suffering from Acute Bacterial prostatitis , Chronic Bacterial Prostatitis . May also Prescribed to Patients suffering from other Types of Prostatitis As the Symptoms are Same among Most of the Prostatitis Types .The Medication can Only be able to Destroy the Bacteria and Symptoms may disappear . The medication can not Cure Prostatitis , Can help the patient to Manage the Symptoms .If there is No Relief From the Symptoms after taking the Avelox The patient then prescribed with other Drugs . Patients Prescribed with Avelox are Found Returning to Clinic after The Whole Treatment Complaining Symptoms Recur .
Also Check: Can Minuteclinic Prescribe Antibiotics For Uti
What Research Is Being Done
Researchers are trying to find out more about prostatitis so that they can develop better treatments.
Theyre looking into the causes of CPPS and why it affects men differently. This includes looking at the genes involved. A better understanding of the causes will mean that, in the future, treatments can be tailored to suit each man.
Theyre also looking into different treatments. These include a number of medicines, botox, surgery, and using small electrical currents to reduce pain.
Another area of research is looking at ways to help men live with CPPS, such as cognitive behavioural therapy , and ways men can take more control themselves such as with diet and supplements.
At the moment, most of the research is happening in other countries, but if youre interested in taking part in a clinical trial, mention this to your doctor. There might be trials you can join in the future.
What Questions Should I Ask My Doctor
You may want to ask your healthcare provider:
- What type of prostatitis do I have?
- What is the best treatment for this type of prostatitis?
- What are the treatment risks and side effects?
- How can I avoid getting prostatitis again?
- What type of follow-up care do I need after treatment?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Prostatitis is a common problem that affects many men. Unfortunately, theres a lot of confusion about the disease. People use the word prostatitis to describe four different conditions. There isnt a one-size-fits-all treatment for prostatitis, which is why an accurate diagnosis is so important.
You May Like: Can You Treat Sinusitis Without Antibiotics
How Are Bacterial Forms Of Prostatitis Managed Or Treated
Antibiotics can kill bacteria that cause bacterial types of prostatitis. Men with acute bacterial prostatitis may need 14 to 30 days of antibiotics, starting with IV antibiotics in the hospital. Rarely, men need surgery to drain an abscess on the prostate.
Treating chronic bacterial prostatitis is challenging. You may need up to three months of antibiotics to sterilize the prostate. If the prostate cant be sterilized, low-dose antibiotics can be used long term to prevent recurrences. Some men need surgery to remove prostate stones or scar tissue in the urethra. Rarely, surgeons remove part or all of the prostate gland .
Recommended Reading: What Is The Best Antibiotic For Oral Infection
What Are The Symptoms Of Prostatitis
Symptoms differ depending on whether the prostatitis is acute or chronic.
Symptoms of acute prostatitis may include:
- Pain around the penis, testicles, anus, lower abdomen or lower back. May be severe
- Pain when defecating
- Pain when urinating , frequent urination (especially at night, urgent urination, problems starting or stop-start peeing, or blood in the urine
- Complete inability to urinate
- Feeling unwell, with aches, pains and possibly a fever
- Thick discharge from the penis
Symptoms of chronic prostatitis generally last for at least 3 months and may include:
- Pain around the penis, testicles, anus, lower abdomen or lower back. May be severe
- Pain when urinating , frequent urination (especially at night, urgent urination, problems starting or stop-start peeing, or blood in the urine
- An enlarged or tender prostate on rectal examination, although in some cases it may be normal
- Erectile dysfunction, pain when ejaculating or pelvic pain after sex.
Read Also: Can You Fight Pneumonia Without Antibiotics
The Shift In Bacterial Etiology
As early as 2003, Bundrick et al, have described that E. faecalis and E. coli were the most common isolates the former was the major infection among cohorts of patients with CBP . An epidemiological investigation of the uropathogens among 6221 Italian patients with CBP from January 1997 to December 2008, showed that incidence of gram-positive was higher than gram-negative bacteria, and E. faecalis prevalence increased within 2006â2008 . Moreover, E. faecalis prevalence has also been reported in North America not just to Italy. Recently, a clinical and microbiological survey of 332 cases of CBP showed that E. faecalis was the main etiologic agent , followed by E. coli among patients diagnosed microbiologically with CBP . These results indicate that the predominant etiologic determinant of CBP is gradually transferring to E. faecalis, which belongs to gram-positive microorganisms. Wagenlehner indicated that the improved clinical use of fluoroquinolones for CBP patients increased the trend of gram-positive infections .
The evaluation of microbiological characteristic for each CBP patients to perform a correct, appropriate, and personalized treatment schedule is essential . Therefore, Magri, V et al. proposed to dismiss empirical therapy to avoid catastrophic consequences in terms of chemoresistance and poor clinical practice .
Recommended Reading: Cranberry Juice Good For Prostate
What Are The Causes Of Prostate Infection
If the prostate gland becomes swollen and tender, it is called prostatitis or prostate infection. The prostate gland is a walnut-shaped organ that lies just below a man’s urinary bladder. The prostate produces a fluid that goes into the semen. An inflamed or infected prostate gland may be seen in men of all ages. While the exact cause of prostate infection isnt known, some cases of prostatitis are clearly related to bacterial infections. Bacterial prostatitis isnt contagious and isnt a sexually transmitted disease. Below are a few common causes of prostate infection:
- Severe injury to the groin
- Recurrent use of a urinary catheter
- Prostate biopsy
Also Check: Dog Urinary Tract Infection Antibiotics
What Are The Remedies For Prostate Infection
The common remedies of prostate infection include:
Warm baths called sitz baths
Local heat therapy with hot water bottles or heating pads
Physical therapy:
- Kegel exercises: Tightening and relaxing the muscles that hold urine in the bladder and hold the bladder in its proper position. These are also called pelvic muscle exercises.
- Myofascial release: Pressing and stretching, sometimes with cooling and warming, of the muscles and soft tissues in the lower back, pelvic region, and upper legs. It is also known as myofascial trigger point release.
Phytotherapy: Plant extracts such as quercetin, bee pollen, and saw palmetto may help in relieve symptoms.
Avoiding food that triggers symptoms such as caffeine, spicy foods, and alcohol
Using a cushion if you will be sitting for a long time
Clinical Presentation And Diagnostic Evaluation
ABP typically presents abruptly with voiding symptoms and distressing but poorly localized pain and is often associated with systemic findings . Clinicians should enquire about urogenital disorders, recent genitourinary instrumentation, and new sexual contacts. Only 5% of men with ABP develop CBP, and 2% develop a prostatic abscess. CBP usually presents with more-prolonged urogenital symptoms. The hallmark is relapsing UTI , but < 50% of patients with CBP have this history . Between symptomatic UTIs, patients may be asymptomatic, despite ongoing prostatic infection.
Physical examination should include obtaining vital signs and examining the lower abdomen , back , genitalia, and rectum. Digital prostate palpation in ABP can cause discomfort and can potentially induce bacteremia but is safe if done gently. In ABP, the gland is typically tender, swollen, and warm, whereas in CBP, there may be some tenderness, softening , firm induration, or nodularity.
Recommended Reading: Antibiotic Eye Drops Over The Counter Walgreens
Treating Bacterial Prostatitis By Type
Bacterial infection can cause two types of prostatitisacute and chronic .
Acute Bacterial Prostatitis
The main treatment for acute bacterial prostatitis is the use of antibiotics to kill the bacteria. Depending on the antibiotic and the type of bacteria, this treatment can last anywhere from several weeks to a few months. Escherichia coli infections are one of the most common causes, with this species of bacteria found in 65 to 80 percent of cases.
Severe infections may require hospitalization for monitoring and additional antibiotics. In addition, the infection can cause the prostate to grow bigger and block the urethra, the tube that removes urine from the body. Such blockages are especially important to treat so as to prevent urine from backing up in the urinary tract and damaging the kidneys.
Chronic Bacterial Prostatitis
With chronic bacterial prostatitis, bacteria can linger in the prostate even after treatment about 5 percent of men with acute bacterial prostatitis end up with the chronic type. E. coli has been implicated in chronic prostatitis, too, as has a species of Corynebacterium. When these bacteria hang around, they can also cause occasional urinary tract infections.
What Are Prostate Infections And Prostatitis
The prostate gland is a part of a mans reproductive system, secreting fluids that help transport sperm. The gland lies just below the bladder and surrounds the urethra .
Prostate infections may irritate the prostate and cause inflammation and swelling of the gland. Prostate infections occur most often in men aged 30-50 years but can occur in older men. Unfortunately, many people equate the terms prostate infection and prostatitis, but prostate infections comprise only two of the four major classifications of the term prostatitis, and infectious types comprise only a few of the total number of prostatitis diagnosed patients.
The National Institutes of Health consensus panel has designated four types of prostatitis classifications.
The NIH has established extensive criteria for chronic pelvic pain syndrome that excludes infection and other problems and is as follows:
Inclusion Criteria
- male, at least age 18
- pain or discomfort in the pelvic area for at least 3 months
Exclusion Criteria
This classification system is important to understand because about 90% of men with prostatitis symptoms are diagnosed with chronic pelvic pain syndrome and, by definition, do not have infectious prostatitis.
Stress and depression are common in men with chronic infectious prostatitis.
Also Check: How To Get Over Sinus Infection Without Antibiotics
Can Complementary Therapies Help
Many men find complementary therapies help them deal with their symptoms and the day-to-day impact of their prostatitis, helping them feel more in control. Some men find they feel more relaxed and better about themselves and their treatment.
Complementary therapies are usually used alongside medical treatments, rather than instead of them. Some complementary therapies have side effects and some may interfere with your prostatitis treatment. So tell your doctor or nurse about any complementary therapies youre using or thinking of trying.
You should also tell your complementary therapist about your prostatitis and any treatments youre having, as this can affect what therapies are safe and suitable for you.
Some GPs and hospitals offer complementary therapies. But if you want to find a therapist yourself, make sure they are properly qualified and belong to a professional body. The Complementary and Natural Healthcare Council have advice about finding a therapist.
The following are examples of complementary therapies that some men use.
Be very careful when buying herbal remedies over the internet. Many are made outside the UK and may not be high-quality. Many companies make claims that arent based on proper research. There may be no real evidence that their products work, and some may even be harmful. Remember that even if a product is natural, this doesnt mean it is safe. For more information about using herbal remedies safely visit the MHRA website.
