Health and Prostate

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

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

Localization

Posted by admin on June 21st, 2011 No Comments
The localization method is the most accurate and efficient method of distinguishing between urethral, bladder, and prostate sources of inflammation or infection. The localization technique was initially described by Meares and Stamey et al. in 1968 and has become the standard for a thorough and methodic evaluation of prostatitis syndromes. Surprisingly, few primary care physicians and only about 50% of urologists perform localization evaluations on patients. In fact, one study revealed that only 33 to 45% of urologists even cultured urine or prostatic fluid as part of their evaluation. Physicians cite several reasons for not performing this basic and important diagnostic measure: it is cumbersome, perceived to have a low yield, and perceived to possess high false negative and false positive rates with low predictive value. Such a low percentage of physicians utilizing these basic diagnostic measures may impact adversely on treatment outcomes. Localization culture techniques have been described in detail elsewhere and will be briefly described here. The procedure involves analyzing aliquots of 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

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

Chemotherapy: Introduction

Posted by admin on December 28th, 2009 No Comments
The use of antibiotic combinations for the treatment of bacterial infections has been the subject of many reviews (Garrod 1953, 1964, Chabbert 1953, Dowling 1957, Jawetz 1958, Lacey 1960). All the authors take the view that double chemotherapy is only justified for certain specific reasons, and condemn factory-made mixtures of antibiotics, on the grounds that it is important to prescribe the two antibiotics in appropriately chosen doses. Moreover, the trade name of a mixture often gives no indication of the drugs it contains and may suggest to the uninitiated that it is a new antibiotic, rather than a mixture of two well known ones. The reasons suggested for double chemotherapy are: (1) To achieve a synergic effect. (2) To delay the emergence of resistant strains. (3) To prevent super infection. (4) To treat relatively inaccessible bacteria. (5) To treat mixed infections. (6) To treat undiagnosed infections. In addition some people have recommended the use of two drugs in order to achieve good therapeutic results with small doses of drugs which would be too toxic to use in larger doses, Read more [...]
Posted in Treatment

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

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