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Benign Prostatic Hyperplasia – Prostate Cancer – Prostatitis
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Posts Tagged ‘Norfloxacin’

Antibiotics

Posted by admin on June 21st, 2011 No Comments
Most urologists will treat prostatitis empirically with a course of antibiotics prior to receiving the results of any bacteriologic studies that are performed. Furthermore, most would continue the antibiotic for a full course (2 to 12 weeks), irrespective of the culture results. The only change, typically, would be considered if the antibiogram indicated that a particular organism was resistant to the antibiotic employed. The time course for treatment is highly variable. Most authors and research indicate that a period of 30 days is adequate but literature exists to support as long as 3 to 6 months of therapy. A number of antibiotics have been touted as the most appropriate for the treatment of classic chronic bacterial prostatitis or category II; these drugs should be used in category IIIA as well. Carbenicillin indanyl sodium (Geocillin-Roche) was probably the first antibiotic to have a specific indication for the treatment of prostatitis. It has an excellent spectrum of activity but it is cumbersome for patients as it is dosed four times a day. The tetracyclines as a group have an appropriately Read more [...]
Posted in Prostatitis

Therapy and Prognosis

Posted by admin on June 21st, 2011 No Comments
Antimicrobial Therapy For an antimicrobial agent to be effective against prostatic infection, several properties of the agent must be met. First, the drug must achieve adequate bactericidal levels in both urine and prostate. Most commonly used agents today attain 50- to 100-fold greater urinary concentrations than serum concentration. Second, to enter the prostate under noninflammatory conditions, the agent should be lipid soluble and exist in the nonionized form. Once inside the prostate, the ideal agent should exist as a basic ion to trap itself within the prostate.''' The fluoroquinolones meet most of the above criteria and are the first agents of choice in treating bacterial prostatitis. Some have questioned whether an inflamed prostate represents a similar environment to the uninflamed prostate with respect to pharmacodynamics. To address this question, a group of investigators induced prostatitis in rats and then treated the animals with norfloxacin, followed by assays for intraprostatic norfloxacin levels. The authors found no difference in levels or efficacy of the antimicrobial and concluded Read more [...]
Posted in Prostatitis

Fluoroquinolone (Quinolone) antibiotics. Clinical Uses. Part 2

Posted by admin on December 4th, 2009 No Comments
Prostatitis Fluoroquinolones have been shown to penetrate into prostatic tissue in concentrations approaching or exceeding by severalfold those in serum (see preceding section). In the only comparative study, when each drug was given for 4 to 6 weeks, norfloxacin was shown to be more effective (P = 0.) than trimethoprim-sulfamethoxazole (TMP-SMX) for therapy of chronic bacterial prostatitis caused predominantly by E. coli. In two open studies also using prolonged therapy, norfloxacin and ciprofloxacin appeared to eradicate E. coli prostatitis in 85 to 92% of patients followed for at least 4 to 6 weeks after completion of therapy. Lower rates of eradication by ciprofloxacin have been associated with therapy given for only 2 weeks and with prostatitis caused by bacteria other than E. coli, including P. aeruginosa and enterococci. Pefloxacin has been reported to be effective in 21 of 31 cases (68%) of chronic prostatitis, with two of eight failures associated with the development of resistance. Acute prostatitis caused predominantly by enteric gram-negative bacilli was also cured at 7 months follow-up Read more [...]
Posted in Drugs: Antibiotics

Fluoroquinolone (Quinolone) antibiotics. Clinical Uses. Part 1

Posted by admin on December 4th, 2009 No Comments
Urinary Tract Infections Many of the newer fluoroquinolones achieve high concentrations in human urine (see preceding section). Although the antimicrobial activities of these agents are diminished in the presence of urine, urinary drug concentrations for most agents substantially exceed the minimum inhibitory concentrations (MICs) for both gram-negative and gram-positive urinary tract pathogens, including members of the Enterobacteriaceae, P. aeruginosa, enterococci, and Staphylococcus saprophyticus. Of the newer fluoroquinolones, norfloxacin and ciprofloxacin have been studied most extensively. Studies with norfloxacin and ciprofloxacin have been reviewed recently. In the two largest randomized studies of uncomplicated urinary tract infections comparing therapy with norfloxacin (400 mg given orally twice daily for 3 to 7 days) and that with trimethoprim-sulfamethoxazole (TMP-SMX), eradication of bacteriuria was significantly higher after treatment with norfloxacin in a double-blind randomized study or comparable in the two groups. Similar results were seen in a large number of other comparative Read more [...]
Posted in Drugs: Antibiotics

Diagnosis and Treatment of Prostatitis. Part 4

Posted by admin on December 2nd, 2009 No Comments
Antimicrobial Regimens for the Treatment of Acute and Chronic Bacterial Prostatitis Drug class Dose* and Route Common Side Effects Comments Trimethoprim/ sulfamethoxazole 160 mg TMP–800 mg SMX PO BID Nausea, vomiting, diarrhea, photosensitivity May be used for suppressive therapy as one single-strength tablet given once a day Fluoroquinolones ofloxacin 200 mg–400 mg PO BID Nausea, vomiting, dizziness, insomnia, photosensitivity Drug-drug interactions with theophylline, caffeine, warfarin and other drugs metabolized by the cytochrome p450 system. Drug-nutrient interactions with di– and trivalent cations (e.g., Mg, Al, Ca, Fe, Zn, and Cr) norfloxacin 400 mg PO BID ciprofloxacin 250 mg–500 mg PO BID Aminopenicillins ampicillin 2 gm IV Q6h Diarrhea, rash, hypersensitivity reactions Contraindicated in patients with a history of penicillin anaphylaxis amoxicillin 500 mg PO Q8h Aminoglycosides gentamicin 1 mg/kg–2 mg/kg Q8h Nephrotoxicity, vestibular and auditory toxicity Serum concentrations need to be 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

Diagnosis and Treatment of Prostatitis. Part 2

Posted by admin on December 1st, 2009 No Comments
Acute Bacterial Prostatitis Acute bacterial prostatitis (ABP) is the least common of the prostate infections. It is usually accompanied by a urinary tract infection with positive cultures from prostatic secretions. It presents with a sudden onset of fever, chills, and low back and perianal pain. Patients often complain of obstructive (dysuria, nocturia, urgency, frequency, and burning) and irritative (hesitancy, straining, dribbling, weak stream, and incomplete emptying) urinary symptoms. Other constitutional symptoms include generalized malaise, arthralgias and myalgias. Physical examination reveals a warm, tender, swollen and indurated prostate. The diagnosis of acute bacterial prostatitis can be made based on clinical signs and symptoms. Often, urinary cultures are positive and reveal Escherichia coli as the most prevalent pathogen. Other Gram-negative microorganisms from the Enterobacteriaceae class, such as Proteus sp. and Klebsiella sp., may also be present. In patients who present with a recent history of hospitalization and/or broad-spectrum antimicrobial use, a high index of suspicion Read more [...]
Posted in Prostatitis

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