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

作　　者：Vittorio Magri Emanuele Montanari Visnja Skerk Alemka Markotic Emanuela Marras Antonella Restelli Kurt G Naber Gianpaolo Perletti 

机构地区：[1]Urology and Sonography Secondary Care Clinic, Azienda Ospedaliera Istituti Clinici di Perfezionamento, Milano 20132, Italy [2]Clinica Urologica III, University of Milan/San Paolo Hospital, Milano 20142, Italy [3]University Hospital for Infectious Diseases Dr. Fran Mihaljevic, Zagreb 10000, Croatia [4]Laboratory of Toxicology and Pharmacology, Department of Biomedical, Informatic, Environmental and Communication Sciences, Universita degli Studi dell＇Insubria, Busto A.Narese 21052, Italy [5]Microbiology Unit, Fondazione I RCCS Osp. Maggiore Policlinico Mangiagalli Regina Elena, Milano 20122, Italy [6]Technical University, Munich 80333, Germany

出　　处：《Asian Journal of Andrology》2011年第6期819-827,共9页亚洲男性学杂志（英文版）

摘　　要：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 （500 rag, thrice-weekly） with a once-daily 500- or 750-mg dose of ciprofloxacin （Cipro-500 or Cipro-750 cohort, respectively）. Combined administration of azithromycin （1500 mg week^-1） with ciprofloxacin at the rate of 750 mg day^- 1 for 4 weeks rather than at 500 mg 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.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 （500 rag, thrice-weekly） with a once-daily 500- or 750-mg dose of ciprofloxacin （Cipro-500 or Cipro-750 cohort, respectively）. Combined administration of azithromycin （1500 mg week^-1） with ciprofloxacin at the rate of 750 mg day^- 1 for 4 weeks rather than at 500 mg 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.

关 键 词：AZITHROMYCIN chronic bacterial prostatitis chronic pelvic pain syndrome CIPROFLOXACIN erectile dysfunction InternationalIndex of Erectile Function （IIEF） National Institutes of Health Chronic Prostatitis Symptom Index （NiH-CPSI） 

分 类 号：S858.216.4[农业科学—临床兽医学] TQ465.5[农业科学—兽医学]