Chronic Bacterial Prostatitis

In only about 10% of men with symptoms of chronic prostatitis/chronic pelvic pain syndrome can bacterial infection of the prostate be demonstrated by the Meares & Stamey 4-glass or the pre and post prostate massage (PPM) 2-glass test. Chronic bacterial prostatitis is mainly caused by Gram-negative uropathogens. The role of Gram-positives, such as staphylococci and enterococci, and atypicals, such as chlamydia, ureaplasmas, mycoplasmas, are still debatable. For treatment, fluoroquinolones are considered the drugs of choice because of their favorable pharmacokinetic properties and their antimicrobial spectrum. Because relapse and reinfection are major problems in chronic bacterial prostatitis, only the results of studies with a follow-up period of at least 6 months are meaningful. Analyzing the concentrations of various fluoroquinolones in prostatic and seminal fluid as well as in prostatic tissue, however, it becomes obvious that the fluoroquinolones differ not only in plasma concentrations but also in their penetration ability to these sites. Nevertheless, overall the concentrations at the site of infection of most of the fluoroquinolones with this indication should be sufficient for the treatment of chronic bacterial prostatitis and vesiculitis caused by highly susceptible pathogens. However, the increasing resistance of Escherichia coli, the most frequent uropathogens, against fluoroquinolones in many countries is of great concern.