Bacterial prostatitis: signs, pathogens, causes, symptoms. Chronic bacterial prostatitis

Almost every second man faces prostatitis at different ages. This disease is associated with an inflammatory process in the prostate, which can be caused by congestive processes in the pelvic region, various infections, etc. In the case when the result of the analysis showed the presence of pathogens in the secretion of the prostate gland, the doctor diagnoses bacterial prostatitis. Why does the disease develop and how is it treated?

Based on the name, it becomes clear that the main reason for the development of the disease is the entry of bacteria into the prostate. The causative agents can be:

Escherichia and Pseudomonas aeruginosa.
Staphylococcus.
Enterococcus.

Klebsiella.
Enterobacter.

Proteus.
Sexually transmitted infections.

Many pathogenic microorganisms are always present in the human body without harming it. However, when favorable conditions arise, the infection begins to actively develop, causing the disease. Conditions favorable for bacteria include:

Diseases urinary tract.
Bacterial infections that develop in the body and can enter the prostate through the blood or lymph fluid.
Phimosis of the prostate.
Acute epididymitis.
Urethral catheterization.

Dear readers, we invite you to watch the video of the immunologist Georgy Alexandrovich Ermakov about the causes and symptoms of the disease:

Reflux (intraprostatic or urethroprostatic) when pathogens enter the prostate.
Transurethral operations that were performed without prior antibiotic therapy.

Violation of urination due to an abnormal structure Bladder.
Conditions associated with decline immune protection(AIDS, diabetes, hemodialysis procedure, etc.).

When bacteria enter the prostate area, the pathogenic microflora begins to actively develop and an inflammatory process appears in the organ.

Risk factors that increase the likelihood of developing prostatitis include:

The main causes of inflammation of the prostate gland

Prolonged sexual abstinence.
Availability bad habits.
Weakened immunity.

Wrong nutrition.
Dehydration of the body.
A sedentary lifestyle, which leads to the appearance of stagnant processes in the pelvic area.
Frequent stressful situations.

Symptoms

It is simply impossible not to notice the symptoms of bacterial prostatitis, since this form of the disease begins acutely. The patient is concerned about:

An increase in body temperature, accompanied by chills.
Pain in the perineum, lower abdomen and lower back.
Painful urination. The patient notes pain and, which are especially strongly felt at night.
Difficulty urinating, feeling of incomplete emptying of the bladder.
Possible constipation due to compression of the anus by an inflamed prostate.
Signs of intoxication in the body ( headache, general weakness of the body, body aches).
Discharge from the urethra.

A short video will tell you about the main symptoms of the disease and methods of therapy:

Symptoms of the disease also vary depending on the stage of bacterial prostatitis:

At the beginning of the disease, inflammation does not spread beyond the prostate. A man is worried about soreness in the perineum, which can radiate to the sacrum. Urination is frequent and accompanied by pain.
In the second stage, inflammation passes to the lobules of the prostate gland. In this case, the pain intensifies and can radiate to the anus. Urination is significantly disturbed, up to its complete detention.

With the advanced form of bacterial prostatitis, the inflammation spreads to all the lobules of the prostate. The patient complains of signs of general intoxication of the body. Body temperature rises to 40 degrees. Urinary retention becomes acute. There are pulsating sensations in the perineum. Frequent constipation occurs.

Possible Complications

With untimely or poor-quality treatment, acute bacterial prostatitis can cause serious harm to the health and life of a man. The most dangerous of them is sepsis.

Also, the infection can rise above the prostate gland and lead to pyelonephritis or.

Bacterial prostatitis can turn into, the treatment of which is often difficult and leads to complications such as adenoma, infertility, impotence, etc.

Diagnostics

Since bacterial prostatitis has characteristic symptoms, it is usually fairly easy to diagnose. If the disease is not acute, the doctor will conduct a rectal examination, probing the area of the gland and taking a sample of the secret for analysis. The following studies help to make a diagnosis:

Clinical and bacterial analysis of the patient's blood and urine.
Ultrasound of the prostate.

PSA blood.
Analysis of scrapings of the epithelium from the urethra.

Treatment

The danger of bacterial prostatitis is that it is capable of as soon as possible turn into a chronic form. That is why it is so important to start treatment when a disease is detected. After all, the chronic form of the disease contributes to the spread of the inflammatory process to the surrounding tissues and organs. If you ignore the treatment and do not take it, then the prostate can completely atrophy.

For the treatment of bacterial prostatitis are prescribed. Only a doctor can recommend this or that medicine after examination and obtaining the result of microbiological tests.

Treatment with antibacterial drugs is considered the most appropriate for the bacterial nature of the disease. Due to the fact that antibiotics are able to make the tissues of the organ permeable, the medicine can freely penetrate to the site of inflammation.

In the treatment of bacterial prostatitis, the following antibiotics are prescribed:

Ampicillins ("Amoxiclav", "Augmentin", etc.).
Macrolide preparations ("Azithromycin", "Clarithromycin", etc.) are quite effective in the fight against many pathogens.
Medicines of the cephalosporin group ("Supraks", "Ceftriaxone", etc.) are effective in the acute phase of the disease.

Fluoroquinolones ("Ofloxacin", "Ciprofloxacin", "Levofloxacin") are highly sensitive to many bacteria. Due to the fact that these medicines have a large number of side effects, they are prescribed with caution.
Tetracyclines ("doxycycline") can be difficult to tolerate, so recently, they are prescribed very rarely.

The course of antibiotic treatment cannot be less than 10 days.

Additionally, non-steroidal anti-inflammatory drugs (Ibuprofen, Diclofenac) are used for treatment. They effectively remove pain syndrome and inflammation of the prostate.

If problems with urination are observed, the patient is shown the use of alpha-blockers (Alfuzosin, Tamsulosin, etc.), which lead to a decrease in tension in the smooth muscles of the urethra and bladder.

Often, bacterial prostatitis is accompanied by a depressive state and a frequent change in the patient's mood. In such cases, the doctor recommends the use of drugs with a sedative effect (Afobazol, Miaser, etc.).

Urologist, andrologist Soloviev Nikolai Konstantinovich will talk about the use of antibiotic therapy:

If the disease is severe, the patient needs detoxification treatment, which consists in intravenous administration glucose, saline with trace elements and vitamin complexes. It is important for a man to observe the drinking regimen and drink at least 2 liters of pure water per day.

Medications should be aimed at normalizing blood circulation in the pelvic region and increasing the body's defenses. For this use:

Vitamin and mineral complexes.
Antispasmodics ("No-shpa", "Papazol", "Drotaverine", etc.).
Immunomodulators ("Imunofan").
Biological products ("Vitaprost").

In addition to receiving medicines, the doctor will recommend doing microclysters with a decoction medicinal herbs(chamomile, calendula, etc.). The use of topical preparations in the case of bacterial prostatitis should be strictly limited, as there is a high risk of various complications.

After the elimination of the inflammatory process, the patient is prescribed treatment with physiotherapeutic methods (electrical stimulation of the prostate, magnetic therapy, etc.). They help speed up recovery and are performed on an outpatient basis.

In extreme cases, when medication has not given the desired result, the doctor may decide to perform a surgical operation. Such an intervention consists in resection of the prostate and is usually performed on older men. Young people are not prescribed such treatment because possible complications(enuresis, impotence, infertility).

If bacterial prostatitis has become chronic, it is quite difficult to treat it. It must be remembered that it is no longer possible to do this at home.

Preventive measures

The best bacterial prostatitis is an active lifestyle. This is due to the fact that the gland itself is poorly supplied with blood. Therefore, those who have a sedentary job need to regularly take a break in order to walk around a bit or do something (retracting the muscles of the anus, etc.).

A good effect gives a contrast shower. In this case, the jet of water is directed directly to the perineal area. The time of using warm (hot) water is 30 seconds, cool - should not exceed 15 seconds. The average duration of the procedure should be 5 minutes.

Preventive measures also include:

Prevention of hypothermia of the body.
Fight against constipation. If you can’t get rid of them on your own, you should consult a doctor who will advise mild laxatives.

Normalization of sexual life (choosing a permanent partner, using a condom in case of doubtful contact, avoiding prolonged absence or excessively active sex).

Regular preventive examination by a urologist for all men over 40-45 years old.

Forecast

What are the consequences of bacterial prostatitis in a man? The success of treatment depends on how timely and how well the therapy was prescribed. In addition, this is influenced by the patient's age, lifestyle, stage of the disease, the presence of other diseases of the body, etc.

The acute phase lends itself well drug treatment, which after a few days, significantly improves the condition of the man. But at improper treatment or its interruption, a relapse is possible and the transition of prostatitis to a chronic form, which is much more difficult to cure.

To avoid the unpleasant consequences of bacterial prostatitis, it is important for a man to monitor his health, follow preventive measures, and in case of discomfort in the perineum, consult a doctor.

Effective treatment of bacterial prostatitis largely depends on how the disease is classified (acute or chronic) and what type of infectious agent it is.

This is determined by the diagnosis of the disease: the symptoms of the disease are determined, possible reasons occurrence, etc.

Treatment for bacterial prostatitis can be pharmacological or non-pharmacological.

Drug treatment of bacterial prostatitis can be represented as follows:

taking antibiotics;
taking alpha-blockers if you have problems with urination. These funds help to relax smooth muscle cells in the walls of the bladder and urethra, which normalizes the process of urination;
taking non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain caused by inflammation in the prostate gland. You may be prescribed drugs from the Diclofenac or Ibuprofen group;
if in the course of treatment a man experiences mood swings or the development of depression, then sedatives are additionally prescribed.

Non-drug treatments for bacterial prostatitis include:

folk remedies (usually herbal treatment);
organization proper nutrition(special diets);
physiotherapy.

Disease prevention plays an important role.

Folk remedies for the treatment of bacteria with prostatitis: we select the right diet, we do physiotherapy, we prescribe prevention

Treatment at home:

Pumpkin seeds are extremely effective. It is enough to take 30 seeds per day. The beneficial effect is explained by the fact that pumpkin seeds contain a large amount of zinc, which contributes to the treatment of prostatitis.
Vegetable juice made at home. It is extremely useful to use asparagus. Beets, carrots and cucumbers will also be useful. You need to drink about 50 grams of such freshly squeezed juice per day.
Useful is a decoction of chestnut shells. This decoction should replace the intake of tea and drink it throughout the day.

Physiotherapy

Physiotherapy is prescribed only in two cases: 1 - the man recovered, 2 - the chronic process worsened.

In case of prostatitis, self-treatment is unacceptable.

After examining the patient, the doctor may prescribe the following types of physiotherapy:

prostate massage;
magnetotherapy;
UHF therapy;
laser therapy;
hirudotherapy.

Diet

When organizing proper nutrition, it is strictly forbidden to include the following products in your diet:

Coffee and carbonated drinks.
Juices in tetra-packs.
Alcoholic drinks.
Products for fast food.
Canned products.
Semi-finished products.
Fatty, spicy, smoked and pickled foods.

With improper treatment of bacterial prostatitis (or no treatment), the following complications are possible:

The development of blood clots in the vessels that supply the prostate with blood.
Formation of stones in the prostate.
Manifestation of purulent abscesses in the prostate.
development of prostate adenoma.
The formation of benign prostatic hyperplasia.
Development of erectile dysfunction.
Formation of tumors in the prostate gland (prostate cancer).

Proper prevention of bacterial prostatitis will help reduce the risk of developing the disease, namely:

Proper nutrition, which consists in organizing a suitable diet: healthy foods and adherence to mealtimes.
Regular sexual contacts.
Active lifestyle.
Proper clothing so as not to overheat and not overcool the body.
Rejection of all bad habits: stop drinking alcohol and smoking.

Treatment of chronic bacterial prostatitis is a long and complicated process, since the infection persists in the prostate for a long time. Even in cases where the symptoms of the disease have disappeared, it is necessary to drink a full course of antibiotics, since the infection may persist without symptoms. For the treatment of chronic bacterial prostatitis, it is necessary to identify the type of infection in order to select the appropriate drug, to which the pathogen is hypersensitive.

Acute bacterial prostatitis manifests itself through severe fever. Chills and pain in the lower abdomen appear suddenly, urination is difficult. Treatment consists in the timely administration of antibiotics.

If acute bacterial prostatitis is not treated, it will become chronic.

Antibacterial drugs for prostatitis: what is better to choose

Antibacterial drugs for prostatitis are the main in a medical way treatment for bacterial prostatitis.

Treatment of bacterial prostatitis with antibiotics and antimicrobial agents can be carried out by taking drugs from the groups:

protected penicillins;
macrolides;
tetracyclines;
cephalosporins;
fluoroquinols.

You can make your own suppositories for the treatment of bacterial prostatitis. Propolis is perfect for this. It is necessary to evaporate 40 grams of propolis in a glass of alcohol. Then 0.1 g of the extract is mixed with 2 g of cocoa butter. Small candles are molded from the resulting mixture. At night, such a candle should be inserted into the rectum. The procedure should be carried out within a month.

Treatment of bacterial prostatitis with antibiotics: list of drugs and treatment regimen

Currently, the treatment of bacterial prostatitis with antibiotics is carried out as follows:

a group of aminoglycosides: taking Gentamicin, Kanamycin, 5-NOC;
a group of cephalosporins: the appointment of Ceftriaxone;
penicillin group: taking Amoxiclav;
tetracycline group: taking doxycycline or tetracycline;
group of macrolides: the appointment of Azithromycin, Sumamed, Clarithromycin, Oleandomycin;
a group of fluoroquinolones: taking Norfloxacin, Ciprofloxacin Ofloxacin. Fluoroquinolones have a lower ability to penetrate the prostate tissue, but these drugs are prescribed if other antibiotics are contraindicated in the male body.

Treatment regimen for bacterial prostatitis

A man should be examined to identify the type of pathogen (the sensitivity of microorganisms to drugs of a particular group) and prescribe the necessary antibiotic. This analysis is carried out using the study of prostate juice.

Antibiotics in the treatment of bacterial prostatitis should be drunk for an average of two weeks. Then re-analyze the juice of the prostate. If the pathogen is found again, then antibiotics may be extended for a week or replaced with another type of medication. If the treatment is carried out in a timely manner and with properly selected antibiotics, then prostatitis will be completely cured. Otherwise, the disease may become chronic.

Many men drink antibiotics for prostatitis without the knowledge of the doctor, not knowing the causes of the disease and the characteristics of its course. This leads to the ineffectiveness of self-therapy, the development of resistance of pathogens and other undesirable consequences. Appointment expediency antibacterial agents determined by the attending physician based on the results of the research.

When Antimicrobials Are Necessary

Not every patient with prostatitis needs antibiotics. For their appointment, laboratory diagnostics confirming the presence of a bacterial nature of the disease. The infection happens:

Primary. When a pathogen causes disease.
Secondary. If the infection has joined after the development of the inflammatory process.

In addition to bacteria chronic inflammation provoke:

trauma;
overweight;
circulatory disorders in the pelvic area;
hypothermia;
passive lifestyle;
associated diseases of the genitourinary system.

If the pathologies are not complicated by bacteria, then the antibiotic will be useless. Unnecessary treatment often leads to undesirable or dangerous consequences.

Bacteria are able to adapt to changes environment. If antimicrobial agents are taken in violation of dosages or too often, microorganisms get used to the medicine. The next treatment with the same drug will be ineffective. A man will need to prescribe other drugs that have a greater toxic effect on the body, mainly on the kidneys and liver.

Another disadvantage of self-treatment is the difficulty of diagnosis. If the treatment of prostatitis is unsuccessful, the patient is forced to turn to a urologist, who often makes an incorrect diagnosis due to erased symptoms and distorted laboratory test results. The attending physician will tell you which antibiotics to take for prostatitis.

To accurately determine whether antibacterial medications are needed for prostatitis or not, you need to come to the hospital and undergo an examination. Initially, the doctor palpates the gland through the anus, after which he writes out a direction for:

general analysis of blood and urine;
culture of urine and prostate secretions;
scraping from the urethra;
determination of the level of prostate-specific antigen, which is the primary criterion for the detection of prostate cancer;
Organ ultrasound.

If the leukocytes found in the prostatic juice are below 25, a stress test is performed. To do this, they take Omnic medication for a week, after which they repeat the sampling of the biomaterial. The result of general tests and PCR is the fastest to come. You can get the necessary data just a few days after sampling. Which antibiotics for prostatitis will be effective is decided by the results of bakposev, which is done about a week. a bacterial inflammatory process is diagnosed when the first test did not reveal any abnormalities, but under load there was a jump in leukocytes. When the above studies are normal, then the bacteria are not related to the development of prostatitis and you need to look for another reason:

If the patient independently took antimicrobial tablets, then the culture is clean. After a while, the pathology returns and is more difficult to treat. If the fact of self-administration of antibiotics was present, it is necessary to tell the doctor about it. This will save both of them time.
Sometimes it happens that prostatitis is non-infectious in nature, but pathogenic microorganisms are found in the urethra. In this case, the use of antibacterial agents is necessary. It will eliminate pathogens and prevent secondary infection of the prostate.
Less common cause of inflammation is tuberculosis. Contrary to popular belief, it affects not only the lungs and bones, but also the tissue of the male gland. Often the infection is hidden and spreads to the seminal vesicles, bladder.

You need to wait about 2.5 months for an analysis for prostate tuberculosis. Its result may be affected by the parallel administration of fluoroquinolone antibiotics.

Treatment of bacterial inflammation of the prostate begins with the selection of a suitable drug. These can be:

tetracyclines;
penicillins;
macrolides;
fluoroquinolones;
cephalosporins.

It is impossible to say which of them is more effective and will work in a particular case. It all depends on the identified pathogen and its immunity to certain drugs. Therapy of bacterial prostatitis lasts 1-2 months, but this does not mean that they drink an antibacterial drug all the time. In the complex appoint:

drugs that improve blood circulation in the pelvis;
anti-inflammatory tablets, injections, ointments or suppositories of non-steroidal origin;
antidepressants, psychostimulants;
medical gymnastics;
lifestyle adjustments;
vitamin complexes to strengthen immunity.

Tuberculous types of prostatitis are difficult to treat. Elimination will take a minimum of 6 months, usually 1-2 years. The doctor selects an individual treatment regimen. It consists of several types of antibiotics that are taken throughout the entire period of treatment.

All drugs in this group have an identical effect - they disrupt the process of protein formation in bacterial cells. They have a wide range of action. They differ in the rate of absorption and excretion, the intensity of exposure. The first tetracyclines were withdrawn in the middle of the 20th century. At that time they were very effective and were often prescribed for the treatment various diseases. As a result, most of the microorganisms have adapted to antibiotics, the drugs have become worse. Inflammation of the prostate is rarely treated with tetracycline, because most strains that cause inflammation are insensitive to it. A characteristic feature of tetracyclines is cross-effect. If one medicine does not work, then there is no point in prescribing another. This group includes:

Tetracycline;
doxycycline;
minocycline;
Metacycline;
Hyoxysone;
Oxycyclosol;
Hyoxysone and others.

Treatment of the prostate is carried out with an antibiotic in capsules, tablets, injection solutions.

This group includes the first and effective antibiotic - Penicillin. It was accidentally discovered by Alexander Fleming, who was working on the study of bacterial infections. As a result of his research, it turned out that the mold is able to destroy pathogens by disrupting the synthesis of peptidoglycan, a substance that is a building component of the cell membranes of microorganisms. Over time, microbes developed resistance, new drugs of the penicillin series were derived, having a natural or semi-synthetic origin. They were divided into:

isoxazolylpenicillins - effective in eliminating staphylococci (Nafcillin, Oxacillin);
aminopenicillins have a wide spectrum of action (Ampicillin, Amoxicillin);
ureidopenicillins, carboxypenicillins destroy Pseudomonas aeruginosa (Piperacillin, Ticarcillin).

Antibiotics of the penicillin series are contraindicated in persons allergic to mold.

Relate to the most safe means antibacterial series. They have a bacteriostatic effect on microorganisms and, when used correctly, are safe for humans. Side effects are rare. No cases were reported during their admission. toxic injury liver, kidneys, dysfunction of blood cells, the appearance of skin sensitivity to sunlight. Substances are active against many microorganisms, but are most often used for respiratory diseases. They have a common structure, but a different spectrum of action. Names of macrolide drugs:

Azitrox;
Azithromycin;
Clarithromycin;
Klacid;
Roxylor;
Rulid;
Sumamed;
Erythromycin and others.

Despite the advantages, such antibiotics against prostatitis are ineffective. Synthetic medicines with a wide spectrum of action and a rather large list of side effects. Among them:

violation of the digestive tract;
pathology of the central nervous system;
negative impact on the musculoskeletal system;
toxic damage to the kidneys and liver;
allergic reactions.

The degree of their severity depends on the dose taken, the duration of treatment and compliance with the instructions. After taking the substance is rapidly absorbed from the digestive tract and penetrates into all organs. Common names:

Pefloxacin;
Gemifloxacin;
Tsiprolet;
Microflox;
Norilet and others.

Fluoroquinolones - effective antibiotics with chronic prostatitis.

Cephalosporins

These drugs cope with microbes, damaging their cell wall, which leads to the death of the latter. Cephalosporins are effective against many pathogens, but are poorly absorbed from the gastrointestinal tract, so they are often prescribed as injections. The drugs have relatively low toxicity and are well tolerated by patients when used correctly. They are often prescribed for inpatient treatment.

The cephalosporin series is represented by drugs of 5 generations, which differ greatly in their spectrum of action. The first generation is effective against gram-positive representatives of the bacterial world. Slightly affects gram-negatives. But fifth-generation drugs are effective for the treatment of strains resistant to the penicillin group.

The list of cephalosporins includes:

Cefuroxime;
Ceftriaxone;
Cefaclor;
Cefoperazone;
Ceftobiprol.

Fifth generation drugs have more side effects, are not prescribed to patients with a history of seizures. Treatment of inflammation of the prostate gland is a complex process, and it should begin with finding out the causes. Based on them, the doctor decides on the advisability of taking antibiotics. Often you can’t do without them, but success primarily depends on the correct choice. Self-treatment of prostatitis with antibiotics often leads to the erasure of symptoms and the development of chronic inflammation.

develops in men of different ages, but due to certain changes, disturbances in the body can occur that provoke inflammation. The result is bacterial prostatitis.

It is difficult to clearly answer the question of what causes the development of this disease.

This may be a hereditary predisposition, previous concomitant diseases of the urogenital area, and so on.

What is prostatitis?

Spicy. The reason for the development of this type of prostatitis is an infection. Sometimes it's E. coli, sometimes it's a fungal infection. Many microorganisms cause a similar anomaly. The chance of developing prostatitis increases in cases where a person does not treat developing caries, tonsillitis, sinusitis, and so on. Acute prostatitis appears almost immediately after the onset of the disease. There is a fever, weakness, similar symptoms with SARS. There is also pain, urination disorders, intimate problems.
Chronic. Various microorganisms penetrate into the prostate gland, which develop in the genital area, and sometimes quite slowly. Such a disease cannot be left to chance, as urgent treatment is required.
Bacterial. It can be chronic or acute. It is caused by the active development of the pathogenic environment - the bacterial flora. Treated mainly with antibiotics.
calculous. It develops when stones appear in the prostate cavity. As a result, the tissues become inflamed.
stagnant. It appears as a result of stagnant processes in the pelvic area, when blood or secretion does not move as a result of a sedentary lifestyle or other reasons. Stagnation of the secret is formed as a result of the lack of a stable sexual life. At the same time, the composition of semen and urine can remain normal, since there are no infectious processes in this disease.
Infectious. Pathogenic microorganisms can affect the prostate and cause congestion and inflammation.
Purulent. A form of difficult flowing infectious prostatitis, accompanied by the release of pus. In this case, there are different subspecies of prostatitis, which depend on the nature of the disease.

Video: "Chronic bacterial prostatitis"

What is bacterial prostatitis

pain, especially during intercourse;
low duration of sexual contact, its poor quality;
discomfort during ejaculation.

How to diagnose?

First, a man should contact a urologist to conduct a preliminary external examination. Further, it is necessary to obtain biological material for carrying out laboratory research. The doctor can perform a palpation examination by inserting fingers into the rectum.

The urologist will recommend to pass the following tests and conduct research:

general blood test (helps to determine the ratio of leukocytes to other components, their number, which will determine the state of immunity and the degree of development of inflammation in the body);
general urinalysis (definition of components that helps build a picture of the genitourinary system);
spermogram (helps to determine the presence of blood in the semen, the number of spermatozoa);
three-glass urine sample (helps to establish the presence of inflammation);
uroflowmetry (analysis of the volume of urine that is reproduced during the day).

Treatment of bacterial prostatitis with antibiotics

The appointment of antibiotics should be individualized. This is due to the fact that in each case the pathogenic environment may differ. Some groups of bacteria can be overcome with some groups of antibiotics, others - with the help of others.

Video: "Antibiotics for prostatitis"

What are antibiotics?

Antibiotics are drugs that are aimed at treating by killing bacteria and some fungal infections. Bacteriostatic and bactericidal - types medicines in the antibiotics group.

The first type is drugs that prevent the growth of bacteria. The second is means that destroy the pathogenic environment. Depending on the nature of the disease, certain remedies are prescribed.

Classification of medicines

Classification of antibiotics:

Penicillins. The action is bactericidal, aimed at destroying the shell of bacteria, which leads to their defeat and destruction. This type of drug is considered a broad-spectrum antibiotic, relevant in the treatment of a number of diseases, including prostate lesions, colds, and others.
Cephalosporins. The action is also bactericidal. In this case, there are 5 subclasses - generations of drugs.
Macrolides. bacteriostatic action. These are broad-spectrum drugs. They get inside the cells, inside which bacteria often hide. There is their destruction and active impact on the pathogenic environment as a whole.
Tetracyclines. bacteriostatic effect. Prescribe treatment infectious diseases with this type of drug.
Aminoglycosides. Mostly with the help of such drugs, diseases of the genitourinary tract, pelvic region are treated.
Fluoroquinolones. Destroy bacteria by stopping the synthesis within bacteria, which leads to their destruction. Medicines used for urinary tract infections respiratory tract, with prostatitis.
Sulfonamides. Antibacterial agents.
Metronidazole.
Enteroseptics, uroseptics. Allow to eliminate infectious diseases.

The most effective drugs in the treatment of bacterial prostatitis

These drugs help with bacterial prostatitis, if appropriate studies have identified this type of disease. There are also other effective drugs, corresponding to the indicated groups, capable of resisting the development

The term "prostatitis" refers to the presence of inflammation in the prostate gland (PG). Chronic prostatitis is the most common urological disease causing complications in the urogenital tract. Among men aged 20–60 years, chronic prostatitis occurs in 20–30% of cases, and only 5% of them seek help from a urologist. With a long course clinical manifestations chronic prostatitis, as a rule, are combined with symptoms of vesiculitis and urethritis.

The development of chronic prostatitis is promoted by hypodynamia, decreased immunity, frequent hypothermia, impaired lymphatic circulation in the pelvic organs, persistence of bacteria different kind in the organs of the genitourinary system. In the age of computer technology, a sedentary lifestyle leads not only to prostatitis, but also to the appearance of problems from the cardiovascular system and the musculoskeletal system.

Currently, there are a large number of classifications of chronic prostatitis, but the most complete and convenient in practical terms is the classification of the American national institute Health (NIH), published in 1995. According to this classification, there are four categories of prostatitis:

I (NIH category I): acute prostatitis - acute infection of the pancreas;
II (NIH category II): CKD is a chronic infection of the pancreas characterized by recurrent urinary tract infection;
III (NIH category III): chronic prostatitis/chronic pelvic pain syndrome - symptoms of discomfort or pain in the pelvic area for at least 3 months. in the absence of uropathogenic bacteria detected by standard cultural methods;
IIIA: inflammatory syndrome chronic pain in the pelvis (abacterial prostatitis);
IIIB: non-inflammatory syndrome of chronic pelvic pain (prostatodynia);
IV (NIH category IV): asymptomatic prostatitis found in men being examined for another disease in the absence of symptoms of prostatitis.

OBP is a severe inflammatory disease and occurs spontaneously in 90% of cases or after urological manipulations in the urogenital tract.

Statistical analysis of the results of bacterial cultures found that in 85% of cases Escherichia coli and Enterococcus faecalis were sown in the bacterial culture of pancreatic secretion. Bacteria Pseudomonas aeruginosa, Proteus spp., Klebsiella spp. are much less common. Complications of OBP occur quite often, accompanied by the development of epididymitis, prostate abscess, chronic bacterial prostatitis and urosepsis. The development of urosepsis and other complications can be stopped with the rapid and effective appointment of adequate treatment.

Chronic bacterial prostatitis (CKD)

CKD is the most common urological disease among men aged 25 to 55 years, is a non-specific inflammation of the pancreas. Chronic nonspecific prostatitis occurs in approximately 20-30% of young and middle-aged men and is often accompanied by impaired copulatory and fertile functions. Complaints characteristic of chronic prostatitis disturb 20% of men aged 20 to 50 years, but only two thirds of them apply for medical care[Pushkar D.Yu., Segal A.S., 2004; Nickel J. et al., 1999; Wagenlehner F.M.E. et al., 2009].

It has been established that 5-10% of men suffer from CKD, but the incidence is constantly growing.

Escherichia coli and Enterococcus faecalis predominate among the causative agents of this disease in 80% of cases, there may be gram-positive bacteria - staphylococci and streptococci. Coagulase-negative staphylococci, Ureaplasma spp., Chlamydia spp. and anaerobic microorganisms are localized in the pancreas, but their role in the development of the disease is still the subject of discussion and is not yet completely clear.

Bacteria that cause prostatitis can only be cultured in acute and chronic bacterial prostatitis. Antibacterial therapy is the mainstay of treatment, and antibiotics themselves should be highly effective.

The choice of antibiotic therapy in the treatment of chronic bacterial prostatitis is quite wide. However, the most effective are antibiotics that can easily penetrate into the prostate and maintain the required concentration for a sufficiently long time. As shown in the works of Drusano G.L. et al. (2000), levofloxacin at a dosage of 500 mg 1 time / day. creates a high concentration in the secretion of the prostate, which is maintained for a long time. The authors noted positive results using levofloxacin two days before radical prostatectomy in patients. Ciprofloxacin for oral administration also has the property to accumulate in the prostate. The idea of using ciprofloxacin has also been successfully introduced by many urologists. These schemes for the use of ciprofloxacin and levofloxacin before prostate surgery are fully justified. The high accumulation of these drugs in the prostate reduces the risk of postoperative inflammatory complications, especially against the background of persistent chronic bacterial prostatitis.

In the treatment of chronic prostatitis, of course, it is necessary to take into account the ability of antibiotics to penetrate into the prostate. In addition, the ability of some bacteria to synthesize biofilms may impair treatment outcomes. Studies on the effectiveness of antibiotics on bacteria have been studied by many authors. For example, M. Garcia–Castillo et al. (2008) conducted in vitro studies and showed that ureaplasma urealiticum and ureaplasma parvum have a good ability to form biofilms, which reduces the effectiveness of antibiotics, in particular tetracyclines, ciprofloxacin, levofloxacin and clarithromycin. Nevertheless, levofloxacin and clarithromycin effectively acted on the pathogen, having the ability to penetrate through the formed biofilms. The formation of biological films as a result of the inflammatory process makes it difficult for the antibiotic to penetrate, which reduces the effectiveness of its effect on the pathogen.

Subsequently, Nickel J.C. et al. (1995) showed the ineffectiveness of treating a model of chronic prostatitis with some antibiotics, in particular, norfloxacin. The authors 20 years ago suggested that the effect of norfloxacin is reduced due to the formation of biofilms by the bacteria themselves, which should be considered as a protective mechanism. Thus, in the treatment of chronic prostatitis, it is advisable to use drugs that act on bacteria, bypassing the formed biofilms. In addition, the antibiotic should accumulate well in the tissues of the prostate gland. Considering that macrolides, in particular clarithromycin, are ineffective in the treatment of E. coli and enterococci, in our study we opted for levofloxacin and ciprofloxacin and evaluated their effect in the treatment of chronic bacterial prostatitis.

Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS)

The etiology of CP and CPPS remains unclear in most cases. However, the analysis of the mechanisms of development of this pathology allows us to identify its main causative factors.

The presence of an infectious agent. DNA-containing bacterial pathogens are often found in the secretion of the prostate during examination of patients, which may indirectly indicate their pathogenicity in relation to the pancreas. The ability to restore the DNA structure of some pathogens, in particular Escherichia coli, other bacteria of the genus Enterococcus, allows microorganisms to exist for a long time in a latent state, without showing themselves. This is evidenced by the data of cultural studies. After antibiotic therapy, bacterial cultures of prostate secretion are negative. But after some time, bacteria capable of restoring their own DNA structure appear again in culture crops.
Violation of the function of regulation of the detrusor. The severity of dysuric phenomena may vary in different patients. HP may be completely asymptomatic. However, ultrasound data confirm the appearance of residual urine in patients with CP. This contributes to excessive stimulation of pain neuroreceptors and the appearance of a feeling of incomplete emptying of the bladder.
Decreased immunity. Conducted immunological studies in patients with CPP showed significant changes in the immunogram. The number of inflammatory cytokines statistically increased in most patients. At the same time, the level of anti-inflammatory cytokines was reduced, which confirmed the appearance of an autoimmune process.
The appearance of interstitial cystitis. Schaeffer A.J., Anderson R.U., Krieger J.N. (2006) showed an increase in the sensitivity of the potassium intravesicular test in patients with CP. But the data obtained are currently being discussed - the possibility of an isolated appearance of CP and interstitial cystitis is not ruled out.
Neurogenic factor in the appearance of unbearable pain. Clinical and experimental data have confirmed the source of pelvic pain, the main role in the origin of which is played by the spinal ganglia, which respond to inflammatory changes in the pancreas.
The appearance of venous stasis and lymphostasis in the pelvic organs. In patients with the presence of a hypodynamic factor, stagnation occurs in the pelvic organs. At the same time, venous congestion is noted. A pathogenetic relationship between the development of CP and hemorrhoids has been confirmed. The combination of these diseases occurs quite often, which confirms the general pathogenetic mechanism of the onset of diseases, based on the appearance of venous stasis. Lymphostasis in the pelvic organs also contributes to the violation of the outflow of lymph from the pancreas, and with a combination of other negative factors leads to the development of the disease.
The influence of alcohol. The impact of alcohol on the reproductive tract not only causes negative consequences for spermatogenesis, but also exacerbates chronic inflammatory diseases including prostatitis.

Asymptomatic chronic prostatitis (BCP)

The chronic inflammatory process leads to a decrease in the oxygenation of the prostate tissues, which not only changes the parameters of the ejaculate, but also causes damage to the structure of the cell wall and the DNA of the epithelial cells of the prostate. This may be the reason for the activation of neoplastic processes in the pancreas.

Material and research methods

The study included 94 patients with microbiologically verified CKD (NIH category II) aged 21 to 66 years. All patients underwent a comprehensive urological examination, which included completing the CP Symptom Scale (NIH-CPSI). general analysis blood tests (KLA), microbiological and immunohistochemical examination of pancreatic secretions, PCR diagnostics to exclude atypical intracellular flora, TRUS of the prostate, uroflowmetry. The patients were divided into two equal groups of 47 people, in the 1st group there were 39 people (83%) aged 21-50 years, in the 2nd group - 41 (87%). 1st group consisting of complex treatment received ciprofloxacin 500 mg 2 times / day. after meals, the total duration of therapy was 3-4 weeks. The second group received levofloxacin (Eleflox) 500 mg 1 time / day, the duration of treatment was 3-4 weeks on average. At the same time, patients were prescribed anti-inflammatory therapy (suppositories with indomethacin 50 mg 2 times / day for 1 week), α-blockers (tamsulosin 0.4 mg 1 time / day) and physiotherapy (magnetolaser therapy according to guidelines). Clinical control was carried out during the entire period of treatment of patients. Laboratory (bacteriological) quality control of treatment was carried out after 4–5 weeks. after taking the drug.

results

Clinical assessment of treatment results was carried out on the basis of complaints, objective examination and ultrasound data. In both groups, the majority of patients showed signs of improvement after 5–7 days from the start of treatment. Further therapy with levofloxacin (Eleflox) and ciprofloxacin showed the effectiveness of treatment in both groups.

Patients of the 1st group showed a significant decrease and disappearance of symptoms, as well as normalization of the number of leukocytes in the secretion of the pancreas, an increase in the maximum volumetric flow rate of urine according to uroflowmetry (from 15.4 to 17.2 ml/s). The average score on the NIH-CPSI scale decreased from 41.5 to 22. The prescribed therapy was well tolerated by patients. 3 patients (6.4%) developed side effects from the gastrointestinal tract (nausea, upset stool) associated with taking the antibiotic.

In patients of the 2nd group treated with ciprofloxacin, there was a decrease or complete disappearance of complaints. The maximum volumetric flow rate of urine according to uroflowmetry increased from 16.1 to 17.3 ml/s. The mean NIH-CPSI score decreased from 38.5 to 17.2. Side effects were noted in 3 (6.4%) cases. Thus, we did not obtain significant differences based on clinical observation of both groups.

In the control bacteriological examination of the 1st group of 47 patients treated with levofloxacin, eradication of pathogens was achieved in 43 (91.5%).

During treatment with ciprofloxacin, the disappearance of the bacterial flora in the prostate secretion was observed in 38 (80%) patients.

Conclusion

To date, fluoroquinolones II and III generations, related to antibacterial drugs broad-spectrum, continue to be effective antimicrobial agents for the treatment of urological infections.

results clinical research did not reveal a significant difference between the use of levofloxacin and ciprofloxacin. Good tolerability of drugs allows them to be used for 3-4 weeks. However, data from bacteriological studies showed the greatest antimicrobial efficacy of levofloxacin compared to ciprofloxacin. In addition, the daily dosage of levofloxacin is provided by a single dose of the tablet form of the drug, while patients must take ciprofloxacin twice a day.

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