Safety considerations with new antibacterial approaches for chronic bacterial prostatitis

ABSTRACT

Introduction

Chronic bacterial prostatitis (CBP) is a difficult-to-eradicate infection. Antibacterial therapy with currently licensed agents is hindered due to the increasing emergence of pathogen resistance worldwide and to frequent infection relapse. With limited treatment options, physicians are investigating new agents, which, however, may raise safety concerns.

Areas covered

Antibacterial agents currently licensed for CBP were not considered. Available reports about the safety and efficacy of antibacterial agents that have been clinically tested or tentatively used to treat CBP in single cases were evaluated. This review also focused on agents targeting Gram-positive pathogens, whose prevalence as causative agents of CBP is increasing.

Expert opinion

(i) Most antibacterial agents considered in this review have been administered off-label in the interest of patients, and their use requires particular caution. (ii) Reports describing the usage of many of the drugs reviewed here are still scant, and readers should be warned of the limited published evidence supporting therapy for CBP with these agents. (iii) As treatment must extend over several weeks, medium-term adverse events may occur and therapy should be individualized, taking into account the dosage and the potential toxicity of each specific antibiotic. Regarding dangerous drug–drug interactions, particular attention should be paid to the risk of ECG-QT-interval elongation.

KEYWORDS:

• Antibiotics
• antibacterial agents
• adverse effects
• safety
• prostatitis
• chronic bacterial prostatitis
• fluoroquinolones

Article highlights

• Chronic Bacterial Prostatitis (CBP) is a difficult-to-eradicate infection. Antibacterial therapy with currently licensed agents is hindered due to the increasing emergence of pathogen resistance worldwide. For this reason, physicians are sometimes forced to administer alternative antibacterial agents, some of which may raise safety concerns.

• We reviewed the available literature concerning the administration of antibacterial agents that have been clinically tested or tentatively used to treat CBP in single cases. Antibacterial agents currently recommended and/or licensed for CBP were not considered

• We noticed that the evidence on the efficacy and safety of certain drugs administered for extended periods to treat CBP is often scant. Thus, clinicians should be warned of the limited published evidence concerning some of the drugs listed in this review, and try to adhere as much as possible to current recommendations. This also shows the need for new adequately powered comparative studies.

• Due to their toxicity, some of the drugs listed in this review (e.g. aminoglycosides) have been infrequently used or have fallen into disuse, the preference being given to agents showing a more favorable safety profile. However, the increasing resistance rates to fluoroquinolones and co-trimoxazole compel clinicians to administer such toxic antimicrobials in the interest of their patients. These agents be administered with particular caution, since prolonged exposure to agents that are designed for short-term administration may cause the onset of adverse effects.

• With few exceptions, most agents listed in this review have been administered to prostatitis patients in an off-label setting. Importantly, off-label drug use requires the consent of the patient, can be strictly regulated in single countries, and may load the prescribing physician with legal responsibilities

Declaration of interest

The author(s) have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.