Chronic
prostatitis is a common condition, with an incidence estimated at between 9%-14% of men worldwide. It is a medically controversial condition with significant attendant morbidity. According to a recent consensus report from the National Institutes of Health (NIH), chronic
prostatitis patients fall into one of three categories:
chronic bacterial prostatitis (category II
prostatitis); chronic
pelvic pain syndrome (category III
prostatitis); or asymptomatic
inflammation (category IV
prostatitis). Prostatic tissues are best penetrated by drugs with a high pKa and high
lipid solubility, such as
quinolones,
macrolides,
tetracyclines, and sulfa drugs.
Ciprofloxacin has been shown to be effective in the treatment of
chronic bacterial prostatitis caused by Escherichia coli. The older
quinolones demonstrate superiority against
chronic bacterial prostatitis caused by gram-negative pathogens; the newer
quinolones may be more effective against gram-positive pathogens and anaerobes. Despite continuing controversy,
antimicrobial agents are the most common
therapy employed in the treatment of chronic
prostatitis. While some patients with nonbacterial (category III)
prostatitis do improve with
antibiotics, prolonged courses in the absence of documented
infection or symptomatic improvement are not warranted. Prospective, randomized, placebo-controlled trials will hopefully lead to a clearer understanding of the role of
antimicrobial agents in
chronic bacterial prostatitis within the next year.