Pharmacotherapeutic interventions for the treatment of bacterial prostatitis

ABSTRACT

Introduction

Bacterial prostatitis, acute or chronic, is one of the most prevalent urogenital infections in men. Its diagnosis requires the application of a careful methodology. Gram-negative bacilli are the most frequent causative agents, and in recent years, an increase in the frequency of multiresistant bacteria has been detected. The choice of the optimal antimicrobial treatment requires the selection of drugs with proven in vitro activity associated with good penetration into the prostatic tissue, especially in chronic forms of infection.

Areas covered

The aim of this article is to summarize the current evidence regarding the pathogenesis, etiology, empirical and definitive antimicrobial therapy, and new pharmacotherapeutic interventions to improve the prognosis of bacterial acute or chronic prostatitis.

Expert opinion

Bacterial prostatitis requires the application of an accurate diagnostic protocol to identify the causative agent and establish the optimal antimicrobial treatment. The structural and biochemical characteristics of prostatic tissue result in poor penetration of antimicrobials; therefore, in the choice of treatment, it is essential to select agents with proven antimicrobial activity and pharmacokinetic characteristics that ensure good and sustained concentrations in this area. Patients with chronic forms of infection require prolonged treatment, and relapses of the infectious process are frequent.

KEYWORDS:

• Antimicrobial therapy
• fluorquinolones
• pharmacotherapeutic
• prostatitis

Article highlights

• Antibiotic resistance of microorganisms causing bacterial prostatitis is increasingly problematic.

• Tailoring antibiotic treatment to culture-proven bacterial sensitivity is essential in the management of ABP.

• Fluoroquinolones are the antimicrobial of choice for the treatment of ABP. Scarce data are available for other alternatives in cases of resistance to fluoroquinolones.

• Recurrence of chronic bacterial prostatitis is common, even using the best antimicrobial agents available.

• New interventions, such as direct injections of antibiotics, plant extracts or phage therapy, are being studied.

This box summarizes key points contained in the article.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Reviewer disclosures

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

Additional information

Funding

This paper was not funded.