Antimicrobial Treatment in Patients with Prostatitis Syndrome

Antimikrobno liječenje indicirano je u bolesnika akutnim bakterijskim prostatitisom, kroničnim bakterijskim prostatitisom, upalnim oblikom sindroma kronične zdjelične boli bez dokažljive infekcije kojih su dio i bolesnici s bakterijskim prostatitisom u kojih uzročnik nije dokazan klasičnim mikrobiološkim metodama, te u odabranih bolesnika s neupalnim oblikom sindroma kronične zdjelične boli bez dokažljive infekcije i s asimptomatskim upalnim prostatitisom. Azitromicin je lijek prvog izbora u liječenju prostatitisa uzrokovanog Chlamydijom trachomatis i Ureaplasmom urealyticum. Preporučuje se u ukupnoj dozi od 4,0 do 4,5 g primijenjen intermitentno tijekom 3-4 tjedna. Kada se kronični bakterijski prostatitis očituje težim kliničkim tijekom, preporučuje se kombinirana antimikrobna terapija ciprofloksacinom i azitromicinom koji se tada primjenjuje u pulsnoj terapiji i u ukupnoj dozi od 4,5 do 6,0 grama. U tih bolesnika azitromicin je indiciran zbog svoje protuupalne i imunomodulatorne aktivnosti te djelovanja na bakterijski biofilm.Antimicrobial treatment is indicated in patients with acute bacterial prostatitis, chronic bacterial prostatitis, inflammatory symptoms of chronic pelvic pain syndrome without detectable infection (which also includes patients with bacterial prostatitis in whom the causative pathogen has not been proven by classical microbiological methods), and in selected patients with non-inflammatory chronic pelvic pain syndrome without detectable infection and patients with asymptomatic inflammatory prostatitis. Azithromycin is the drug of choice for the treatment of prostatitis caused by C. trachomatis and U. urealyticum. It is recommended in a total dose of 4.0 to 4.5 grams intermittently administered over 3-4 weeks. If chronic bacterial prostatitis has a severe clinical course, a combined antimicrobial therapy with ciprofloxacin and azithromycin is recommended, where azithromycin is applied as a pulse therapy in a total dose of 4.5 to 6.0 grams. In these patients azithromycin is administered because of its anti-inflammatory and immunomodulatory activity and its effects on bacterial biofilm