The role of antibiotics in chronic bacterial prostatitis

Abstract

The role of antibiotic treatment in prostatitis is described. The selection of an appropriate antimicrobial agent with optimal pharmacokinetics for prostatic secretion and tissue is important, particularly in chronic bacterial prostatitis (CBP). The theoretical background of drug penetration into the prostate is outlined, emphasising the phenomenon of ion trapping and the role of non-ionic diffusion of weak acids, bases and amphoteric drugs across biological membranes with a pH gradient. Determination of drug concentrations in human prostatic secretion is problematic because of possible urinary contamination. Studies have been carried out mainly in healthy volunteers. The results must be interpreted with caution if no care was taken to rule out or at least to identify urinary contamination. Analysing the concentrations of various fluoroquinolones in prostatic and seminal fluid as well as in prostatic tissue, it becomes obvious that the fluoroquinolones differ not only in plasma concentrations but also in their penetration to these sites. In spite of intensive investigations, our knowledge is still limited regarding the mechanisms that govern the transport of antibiotics into and their activity in the various prostatic compartments and how these findings can be applied clinically. Nevertheless, the concentrations at the site of infection of most of the fluoroquinolones should be sufficient for the treatment of CBP and vesiculitis caused by susceptible pathogens.