Fluoroquinolone-macrolide combination therapy for chronic bacterial prostatitis: Retrospective analysis of pathogen eradication rates, inflammatory findings and sexual dysfunction

Vittorio Magri, Emanuele Montanari, Višnja Škerk, Alemka Markotić, Emanuela Marras, Antonella Restelli, Kurt G. Naber, Gianpaolo Perletti

Research output: Contribution to journalArticle

Abstract

We previously demonstrated the safety and efficacy of fluoroquinolone- macrolide combination therapy in category II chronic bacterial prostatitis (CBP). The aim of this study is to retrospectively compare the microbiological and clinical findings of two treatment schemes for CBP based on the combination of azithromycin (500mg, thrice-weekly) with a once-daily 500-or 750-mg dose of ciprofloxacin (Cipro-500 or Cipro-750 cohort, respectively). Combined administration of azithromycin (1500mg week -1) with ciprofloxacin at the rate of 750mg day -1 for 4 weeks rather than at 500mg day -1 for 6 weeks increased the eradication rates from 62.35% to 77.32% and the total bacteriological success from 71.76% to 85.57%. A significant decrease in pain and voiding signs/symptoms and a significant reduction in inflammatory leukocyte counts and serum prostate-specific antigen (PSA) were sustained throughout an 18-month follow-up period in both groups. Ejaculatory pain, haemospermia and premature ejaculation were significantly attenuated on microbiological eradication in both groups, but the latter subsided more promptly in the Cipro-750 cohort. In total, 59 Cipro-750 patients showed mild-to-severe erectile dysfunction (ED) at baseline, while 22 patients had no ED on microbiological eradication and throughout the follow-up period. In conclusion fluoroquinolone-macrolide therapy resulted in pathogen eradication and CBP symptom attenuation, including pain, voiding disturbances and sexual dysfunction. A once-daily 750-mg dose of ciprofloxacin for 4 weeks showed enhanced eradication rates and lower inflammatory white blood cell counts compared to the 500-mg dose for 6 weeks. Our results are open to further prospective validation.

Original languageEnglish
Pages (from-to)819-827
Number of pages9
JournalAsian Journal of Andrology
Volume13
Issue number6
DOIs
Publication statusPublished - Nov 2011

Keywords

  • azithromycin
  • chronic bacterial prostatitis
  • chronic pelvic pain syndrome
  • ciprofloxacin
  • erectile dysfunction
  • International Index of Erectile Function (IIEF)
  • National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI)

ASJC Scopus subject areas

  • Urology

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