Trimethoprim | Health and Prostate

Posts Tagged ‘Trimethoprim’

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

Chronic Bacterial Prostatitis in the Elderly

Posted by admin on May 5th, 2011 No Comments

Chronic bacterial prostatitis is now recognized as an important cause of relapses of urinary tract infection in elderly men. It is most commonly caused by E. coli, but Klebsiella-Enterobacter, P. mirabilis, and enterococci are also common causes. S. epidermidis, S. aureus, and diphtheroids have been frequent isolates in some series. Many individuals with chronic infection of the prostate are totally asymptomatic. However, some have perineal discomfort, low back pain, or dysuria. Symptoms of acute urinary tract infection may periodically appear. In fact, chronic bacterial prostatitis is probably the most common cause of relapsing urinary tract infection in men. Fever, if present, tends to be low grade unless pyelonephritis occurs. Rectal examination and intravenous pyelograms are unremarkable unless the patient also has an enlarged prostate from benign prostatic hypertrophy or carcinoma. Because of the focal nature of chronic bacterial prostatitis, needle biopsy of the prostate gland for culture of tissue is unreliable. Demonstration of leukocytes in prostatic fluid is not specific for bacterial Read more [...]

Posted in Prostatitis

MiniDictionary

Posted by admin on October 7th, 2010 No Comments

Prostate gland A structure about the shape of a walnut that wraps around the urethra, where it exits the base of a man's bladder. The prostate gland has three lobes and produces fluid that joins the semen (which the seminal glands produce), the viscous substance that transports sperm through the man's reproductive system and out of the body during ejaculation. For reasons researchers do not understand, the prostate gland gradually enlarges with age, a condition called benign prostatic hypertrophy (BPH). An enlarged prostate gland can compress the urethra, interfering with the flow of urine. Common health conditions affecting the prostate gland include prostatitis. The prostate gland also is a common site for cancer. Prostate cancer is more common after age 60, with an increasing risk with advancing age. A physician can palpate (explore through touch) the prostate gland through digital rectal examination (DRE). DRE can permit the detection of prostate enlargement and sometimes of growths or tumors. Prostatic massage Gentle pressure applied to the prostate gland to expel accumulations of fluid, Read more [...]

Posted in Dictionary

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

The management of benign prostatic hyperplasia: Signs and Symptoms of BPH

Posted by admin on December 17th, 2009 No Comments

The most common sequelae of benign prostatic hyperplasia (BPH) include lower urinary tract symptoms (LUTS), such as hesitancy, interrupted weak urine stream, urgency and leaking or dribbling, and more frequent urination, especially at night (Table 1). The size of the prostate does not always correlate to the severity or range of symptoms. Some men with greatly enlarged glands have little obstruction and few symptoms, whereas other men whose glands are less enlarged have more blockage and increased symptoms. It is also possible that some men may not demonstrate any symptoms until there is severe partial or complete obstruction, known as acute urinary retention. This condition can prevent the patient from voiding at all and usually requires immediate attention. In general, however, BPH progresses very slowly and acute urinary retention is uncommon. Men with benign prostatic hyperplasia who are at highest risk for this complication tend to be elderly and tend to have moderate-to-severe LUTS. Acute urinary retention can result from taking over-the-counter cold medications, allergy medicines, antihypertensive Read more [...]

Posted in Benign Prostatic Hyperplasia

Trimethoprim-sulfamethoxazole in the treatment of chronic prostatitis. Part 3

Posted by admin on December 6th, 2009 No Comments

Results Of the 40 patients who received trimethoprim-sulfamethoxazole for 6 weeks, 9 were classed as failures. These either had no response or relapsed during therapy or relapsed after therapy with unchanged severity of symptoms. Eleven were considered improved on the basis of continued symptomatic improvement or because of a good initial response followed by relapse with symptoms less severe than before treatment. Included in the "improved" group are two patients who initially relapsed but who have since remained asymptomatic on long-term therapy. The 20 patients who have had continued satisfactory relief of symptoms are classified as having good results. Discussion An earlier controlled study compared the results of treatment with sulfamethoxazole with those from the use of trimethoprim-sulfamethoxazole. Only after 6 weeks of treatment was a significant response obtained and this influenced the choice of 6 weeks as the treatment period. A longer period of treatment (12 weeks) produced better results when trimethoprim-sulfamethoxazole (TMP-SMX) was used after a course of Read more [...]

Posted in Prostatitis

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

Trimethoprim-sulfamethoxazole in the treatment of chronic prostatitis. Part 1

Posted by admin on December 6th, 2009 No Comments

Chronic prostatitis is a common condition occurring in younger men which presents problems of diagnosis and treatment. In some patients a bacterial population of known pathogens can be identified in the prostatic fluid. In many others proof of bacterial etiology is lacking. There has therefore been an acceptance of two common forms of the disease, namely chronic bacterial prostatitis and a condition that has been variously termed chronic abacterial prostatitis, nonspecific prostatitis, prostatosis and prostatic neurosis. Despite the refinements of methods of collection and bacteriologic processing of prostatic fluid, certainty of bacterial recovery cannot be assumed. The sample obtained may fail to include fluid from all parts of the gland or, in particular, from the inflamed parts of the gland. The inconsistency of recovery of bacteria from known cases of bacterial prostatitis lends support to this thesis and suggests that the segregation of chronic prostatitis into bacterial and nonbacterial groups is by no means certain. Where episodes of recurrent genitourinary infection such as Read more [...]

Posted in Prostatitis

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