Erythromycin | Health and Prostate

Posts Tagged ‘Erythromycin’

Diagnosis and Treatment of Prostatitis. Part 5

Posted by admin on May 4th, 2011 No Comments

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 Read more [...]

Posted in Prostatitis

Chemotherapy: Drug-Resistance and Superinfection

Posted by admin on December 30th, 2009 No Comments

In the Individual Patient The use of two drugs in combination to delay the emergence of a drug-resistant strain is now a well established principle and is almost universally used in the treatment of tuberculosis. A change in the drug sensitivity of an infecting bacterium during a single short course of treatment does not in fact occur very frequently. On the bacterial side the only organisms likely to show such a change are staphylococci and conform bacilli. When antibiotics have to be given for long periods the danger is increased, and is particularly great in the case of tuberculosis, since tubercle bacilli are nearly as adaptable to antibacterial drugs as are staphylococci and coliform bacilli. Although staphylococci appear to be able to develop resistance to almost any antibiotic, this usually only follows continued use of the antibiotic in a hospital where strains are spreading from patient to patient. With streptomycin, erythromycin, novobiocin and Fucidin, however, resistance develops so rapidly that a gross change in sensitivity of an infecting strain is not infrequent after antibiotic Read more [...]

Posted in Treatment

Chemotherapy: Bactericidal Synergy And Antagonism

Posted by admin on December 29th, 2009 No Comments

Jawetz & Gunnison (1953) in one of their now classic papers on 'Antibiotic Synergism and Antagonism' defined 'synergism' as 'the ability of two antimicrobial drugs acting together to increase markedly the rate of early bactericidal [my italics] action, as compared to the rate with either drug alone, and to kill greater numbers of bacteria or to cure experimental or clinical infections more effectively than could be expected from simple algebraic summation of single drug effects'. Simple summation was termed 'addition' and any combined effect less than the sum was called 'antagonism'. It will be seen from this definition that Jawetz & Gunnison were concerned with the bactericidal, not the bacteristatic, effect of drugs and it has been found in practice that it is synergy of this type which operates in vivo. In special cases a combination of drugs may be qualitatively as well as quantitatively different from the action of either drug alone. Thus the combination of penicillin and streptomycin acting together against enterococci is more effective than any concentration of either drug separately. Read more [...]

Posted in Treatment

Drug Interactions in the Treatment of ED, LUTS and BPH: Clinically Relevant Drug-Drug Interactions

Posted by admin on December 27th, 2009 No Comments

Clinically Relevant Drug-Drug Interactions With the 5-Alpha-Reductase Inhibitors Neither dutasteride nor finasteride have any clinically significant pharmacodynamic or pharmacokinetic adverse drug interactions. Studies show that the 5-alpha-reductase inhibitors do not affect the CYP 450 enzyme system. However, agents that inhibit the CYP 450 3A4 may, in theory, interfere with metabolism of these medications. Therefore, until more data are available, cautious monitoring should follow the concurrent administration of a 5-alpha-reductase inhibitor with an agent known to alter the activity of the hepatic mixed function oxidase enzyme system. Pharmacodynamic Drug-Drug Interactions With PDE-5 Inhibitors Pharmacodynamic drug interactions leading to precipitous hypotension and MI are clinically relevant with PDE-5 inhibitors. All selective inhibitors of cyclic GMP-specific PDE-5 are prone to clinically significant pharmacodynamic interactions with agents that produce vasodilation. The concurrent use of nitrate preparations is a contraindication to treatment with selective inhibitors of cyclic GMP-specific Read more [...]

Posted in Benign Prostatic Hyperplasia

The management of benign prostatic hyperplasia: Pharmacotherapy

Posted by admin on December 21st, 2009 No Comments

Recent developments in drug therapy have reduced the number of surgical procedures needed, although in men with severe symptoms, medications may delay but not prevent the need for surgery. Pharmacotherapy has been shown to result in clinically significant subjective improvement in symptoms with fewer side effects and is a viable initial option for all men. Alpha-blockers and 5-alpha-reductase inhibitors comprise the two classes of drugs used to treat benign prostatic hyperplasia (BPH). Table 2 summarizes the pharmacokinetics, dosing, and availability of the alpha-blockers and 5-alpha-reductase inhibitors for the management of BPH. Table 2. Pharmacokinetics, Dosing and Availability of Agents Used in BPH Therapy Nonselective Alpha-Blockers Selective Alpha1A-Blockers 5-alpha-Reductase Inhibitors Doxazosin (Cardura) Pfizer Terazosin (Hytrin) Abbott Prazosin (Minipress) Pfizer Tamsulosin (Flomax) Boehringer Ingelheim Alfuzosin (Xatral) Sanofi- Synthelabo Finasteride (Proscar) Merck Dutasteride (Avodart) GSK Pharma-cokinetics tmax 1-2 Read more [...]

Posted in Benign Prostatic Hyperplasia

Trimethoprim-sulfamethoxazole in the treatment of chronic prostatitis. Part 2

Posted by admin on December 6th, 2009 No Comments

Treatment Antibiotic therapy with appropriate agents, even in well documented infections, rarely proved successful in the past because the diffusion of most antibacterial drugs from plasma into prostatic fluid provided too low a concentration to be effective. Of many drugs tested for diffusion across the prostatic epithelium only the basic macrolides (erythromycin and oleandomycin) achieved significant concentrations in the prostatic fluid. These drugs are ineffective against the common gram-negative organisms cultured from prostatic fluid. Trimethoprim has been shown in both dogs and man to reach higher concentrations in the prostatic fluid than in serum at the normal pH of prostatic fluid. The concentrations attained in the diseased prostate may be lower, since in prostatitis the prostatic fluid pH may be elevated, but are probably still effective. When trimethoprim is combined with a sulfonamide, synergistic antibacterial activity results, with both a bactericidal effect and delayed emergence of resistant strains. Because of a similar half-life, sulfamethoxazole has been used in Read more [...]

Posted in Prostatitis

Diagnosis and Treatment of Prostatitis. Part 3

Posted by admin on December 2nd, 2009 No Comments

Chronic Bacterial Prostatitis Chronic bacterial prostatitis (CBP) occurs when acute bacterial prostatitis is treated inadequately due to resistance, relapse, short-course therapy or because the ductal anatomy of the peripheral zone of the prostate may have blocked drainage of secretions from the prostate. Rarely will some patients be found who have not had a previous bout of acute prostatitis. The most common clinical feature of chronic bacterial prostatitis is recurrent urinary tract infections. Subsequently, patients will complain of obstructive and irritative urinary symptoms. Physical exam reveals a palpable, tender prostate. However, patients often present asymptomatic, with a normal prostate gland exam. Localizing bacteria from the prostate is paramount in order to diagnose chronic bacterial prostatitis. The Stamy–Meares test is a collection of segmented urine samples from the urethra, bladder, and prostate; it is considered the gold standard for diagnosis. The patient voids and collects the first 5–10 mL of urinary stream (VB1), then collects a midstream specimen of 10–20 mL (VB2), Read more [...]

Posted in Prostatitis

Prostatitis Syndromes. Part 5: Treatment

Posted by admin on November 28th, 2009 No Comments

Experiments in animals show that most antimicrobial agents diffuse very poorly into the prostatic tissue and prostatic secretions. Experimentally, a notable exception was trimethoprim. Trimethoprim diffuses easily into prostatic secretion because of its favorable pharmacokinetics, which includes the pH of the prostatic fluid and tissue as well as the specific negative logarithm of the ionization constant of the drug. Trime-thoprim-sulphamethoxazole or trimethoprim alone have been the antimicrobial agents with the best documented record of success in treating chronic bacterial prostatitis. Theoretically, erythromycin and minocycline also achieve therapeutic levels in the secretions. However, these drugs are characterized by a high incidence of adverse side effects, and neither is really suitable for long-term use. The only antibiotic approved for chronic bacterial prostatitis is carbenicillin. Studies have not confirmed that this is the most appropriate drug for this disease. The new quinolones offer theoretical efficacy in that they do diffuse very freely into the prostatic secretion Read more [...]

Posted in Prostatitis

Posts Tagged ‘Erythromycin’

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