Diagnosis and Treatment of Prostatitis. Part 5
Nonbacterial Prostatitis
Nonbacterial prostatitis (NBP) is the most common type of prostatitis, and occurs eight times more frequently than bacterial prostatitis. Nonbacterial prostatitis presents with the same signs and symptoms as bacterial prostatitis; however, prostatic fluid cultures are negative for presence of bacteria. Inflammation is evident upon prostatic fluid analysis, and can be identified by a minimum of 10 to 15 white blood cells per high power field on microscopic examination. Although controversial, implicated pathogens include Chlamydia trachomatis, Ureaplasma urealyticum, and Trichomonas vaginalis. Minocycline 100 mg twice daily, doxycycline 100 mg twice daily, or erythromycin 500 mg four times daily have been utilized in order to eradicate the suspected pathogens. Erythromycin’s antimicrobial activity is significantly enhanced in the presence of the alkaline pH in prostatic fluid, thus, it achieves high cure rates of prostatic infections. Treatment duration is approximately 2 to 4 weeks. Prolonged therapy after treatment failure is not indicated, since nonbacterial prostatitis is generally self-limiting. Adjunctive recommendations may include sitz baths, normal sexual activity, and analgesics for painful urinary symptoms.
Spicy foods, caffeine, and alcohol should be avoided; they may cause bladder irritation and spasms culminating in reflux of urine into prostatic ducts, thus exacerbating nonbacterial prostatitis symptoms. If symptomatology persists patients should be referred to a urologist for evaluation of serious conditions such as urinary bladder carcinoma and interstitial cystitis.
Conclusion
As the most accessible health care professional, the pharmacist often encounters patients with prostatitis. Treatment of prostatitis is associated with high failure rates; therefore it is paramount that pharmacists counsel patients regarding prostatitis and its treatment. Since prostatitis tends to require prolonged therapy, patients must understand the importance of compliance. Pharmacists must carefully screen for drug interactions that may decrease compliance and efficacy. Furthermore, pharmacists play a vital role in referring patients who are unresponsive to therapy for evaluation of serious underlying conditions.