engleski

Azithromycin in the treatment of chronic bacterial prostatitis

Prostatitis is an inflammatory condition of the prostate that presents with urethral symptoms, prostatic symptoms and sexual dysfunction. It is diagnosed by clinical symptoms and signs, the microscopy of expressed prostatic secretion (EPS) and culture of EPS and segmented urine samples. Prostatitis is chronic when symptoms have been present for at least 3 months. As a part of several scientific research projects we have been prospectively investigating prostatitis syndrome at the Outpatient Department of Urogenital Infections and Sexually Transmitted Diseases, Dr Fran Mihaljevic University Hospital for Infectious Diseases, Zagreb, Croatia, since March 1, 1999 and is still ongoing. We examined more than 3450 patients over 18 years of age with symptoms of chronic prostatitis and no evidence of lower genitourinary tract abnormalities. Azithromycin fulfills the criteria for the treatment of chronic prostatitis and sexually transmitted infections-high efficacy against the most common bacterial agents of urogenital and sexually transmitted infections, acceptable toxicity and tolerability, simple oral use, excellent penetration through chronic inflammatory changed prostate capsule, achieves high concentrations in prostatic tissue and slowly eliminates for 4-8 weeks, has anti inflammatory and immunomodulatory effect, and is active against bacterial biofilm. At total of 307 patients with chronic prostatitis caused by Chlamydia trachomatis were treated with azithromycin in a total dose of 4.0, 4.5 or 6.0 g for 3-4 weeks. Eradication of Chlamydia trachomatis was achieved in about 80%, with 70% of patients clinically cured. There were no statistically significant differences between these three dosage regimens. A total of 82 patients with chronic prostatits caused by Ureaplasma urealyticum were treated with azithromycin in a total dose of 4.5 g for 3 weeks. The eradication of Ureaplasma urealyticum was 85% and clinical cure 76%. Conclusion: azithromycin is an effective and safe antimicrobial drug for the treatment of chronic prostatitis caused by Chlamydia trachomatis or Ureaplasma urealyticum. It is recommended in a total dose of 4.5 g po. during 3 weeks, administered for 3 days weekly in a dose 1x500 mg po. per day. The results of recently published clinical studies on the treatment of chronic bacterial prostatitis with combination therapy with ciprofloxacin and azithromycin are impressive. We also have a limited, but positive experience.

Azithromycin; chronic bacterial prostatitis; treatment

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