Outcome of antibiotic therapy with ciprofloxacin in chronic bacterial prostatitis.

Chronic bacterial prostatitis (CBP) is a rare infection of the prostate with Escherichia coli being the predominant causative pathogen. Appropriate antimicrobial therapy is mandatory for cure. We report on our experience with a 4-week regimen of ciprofloxacin in 40 men suffering from CBP due to E. coli. Follow-up was conducted over a period of 12 to 24 months. The microbiological work-up included an analysis of expressed prostatic secretions (EPS) and semen. Eradication of the pathogen in EPS was achieved in 92% of patients 3 months after therapy and in about 70 to 80% of patients evaluated 12 and 24 months after treatment, respectively. Treatment failure was not associated with the presence of prostatic calculi, as assessed by transrectal ultrasonography. After successful therapy, mean EPS pH decreased significantly from 7.95 to 7.35. Significant bacteriospermia with E. coli was detected in 21/22 (95.5%) patients before treatment and in 6/22 (27.3%) patients 6 months after therapy. Our data reconfirm ciprofloxacin as an excellent antimicrobial agent in the therapy of CBP. However, eradication of the pathogen is unpredictable and cannot be achieved in every case. Further studies should correlate microbiological treatment success with symptomatic relief, as assessed by standardised questionnaires.

Impairment of bacterial clearance induced by norepinephrine infusion in rabbits.

OBJECTIVE: Purpose of the study was to investigate the potential influence of norepinephrine (NE) on immune functions in terms of systemic and organ-specific bacterial clearance in rabbits. DESIGN: To enable quantification of the clearance process, defined numbers of exogenous Escherichia coli (1.3 x 10(8) CFU) were injected intravenously 60 min after starting the NE infusion at a low dose (1 microgram/kg per min, n = 6), causing an increase (30 mmHg) in mean arterial pressure without affecting the oxygen uptake, and at a higher dose (7.5 micrograms/kg per min, n = 6), resulting in a marked decrease (20%) in oxygen uptake, after infusion of NaCl solution (control, n = 6). In additional experiments (n = 6) NE (1 microgram/kg per min) was tested in endotoxemia induced by simultaneous infusion of endotoxin (40 micrograms/kg per h). Parameters monitored were arterial pressure, oxygen uptake, and rates of bacterial elimination from the blood. At 180 min after E. coli injection, the animals were sacrificed, and tissue samples of liver, kidney, spleen, and lung were collected for bacterial counts. RESULTS: NE infusion resulted in a dose-dependent prolonged elimination of the injected E. coli from the blood and in significantly higher (p < 0.05) numbers of CFU in liver and lung compared to the controls. Significant impairment of bacterial clearance was found after shock-producing endotoxemia, whereas simultaneous infusion of NE and endotoxin caused only a slightly delayed blood clearance of the injected bacteria. CONCLUSION: NE dose dependently affected bacterial clearance, which might be due to ischemia-derived hypoxic impairment of the phagocytosis and lysis function of the reticuloendothelial system, whereas NE improved elimination of bacteria in a state of endotoxic shock.

Comparative efficacies of ofloxacin, cefotaxime, and doxycycline for treatment of experimental epididymitis due to Escherichia coli in rats.

The in vivo efficacy of ofloxacin was compared with those of cefotaxime and doxycycline in a rat model of epididymitis due to Escherichia coli. Treatment was started 24 h after infection and was continued for 7 days. Ofloxacin reduced the numbers of E. coli organisms in the epididymides significantly more than the other therapeutic regimens and cured the infection more frequently. Histopathological changes in the epididymides of ofloxacin-treated animals were significantly less severe than those observed in untreated animals. Doxycycline was less effective than ofloxacin but significantly reduced the titers of organisms in rat epididymides. In contrast, despite excellent in vitro activity, cefotaxime failed to reduce the magnitude of infection. The results of this study suggest that ofloxacin may be a very effective antimicrobial agent for the treatment of epididymitis due to E. coli.

Refractory chronic bacterial prostatitis: a re-evaluation of ciprofloxacin treatment after a median followup of 30 months.

A total of 16 men suffering from refractory chronic bacterial prostatitis caused by Escherichia coli was treated with ciprofloxacin for 4 weeks. After a median followup of 30 months (range 21 to 36 months) 10 of the 16 patients were considered cured as judged by bacteriological results and clinical symptoms. In 2 men a second ciprofloxacin regimen obviously showed success also. In 2 patients ciprofloxacin therapy failed and in 2 therapy had to be discontinued due to side effects of the central nervous system.

Chronic bacterial prostatitis: therapeutic experience with ciprofloxacin.

Ciprofloxacin was used for the treatment of refractory chronic bacterial prostatis. 17 men with symptoms of prostatitis for more than one year who had not responded to treatment courses of six weeks trimethoprim-sulfamethoxazole or trimethoprim alone received 500 mg ciprofloxacin twice daily per os for two weeks. Up to one year follow-up proved eradication of Escherichia coli in seven of ten and of other pathogens in two of five cases. In a second study, 16 patients with proven chronic bacterial prostatitis who had failed on pretreatment with co-trimoxazole, trimethoprim or norfloxacin, respectively, received 500 mg ciprofloxacin twice daily for four weeks. E. coli was the causative organism for all cases. After a median follow-up of 30 (21-36) months, ten out of 16 patients are clinically cured with permanent eradication of the causative organism. In two men a second treatment course with ciprofloxacin is considered successful. Two patients stopped treatment for central nervous system complaints.

Treatment of chronic bacterial prostatitis with ciprofloxacin. Results of a one-year follow-up study.

In a one-year follow-up study, short-term therapy with ciprofloxacin proved to be beneficial in the treatment of chronic bacterial prostatitis, particularly in cases of Escherichia coli prostatitis. Ciprofloxacin therapy of E. coli prostatitis was a complete success in five of 12 patients, a probable success in two, and in one patient the outcome cannot be judged. Ciprofloxacin treatment failed in three men, and therapy was discontinued in one patient because of side effects. Enterobacter aerogenes prostatitis was cured. Ciprofloxacin treatment was insufficient in three patients with Streptococcus faecalis prostatitis and in one patient with Pseudomonas aeruginosa prostatitis.