Local injection of antibotic in refractory chronic bacterial prostatitis

ABSTRACT

Prostatitis is a widespread condition in men with an estimated prevalence of 10%. When there is a good clinical and bacteriological evidence of infection, systemic antibiotic therapy is usually prescribed on a long-term basis. This therapy is not optimal because of its high coast and significant side effects with a high relapse rate. As such we have evaluated the role of local intraprostatic injection of antibiotic in patients with resistant chronic bacterial prostatitis. Patients and A total of 54 patients diagnosed as having chronic bacterial prostatitis, based on a positive culture of either expressed prostatic secretion [EPS] or post massage urine specimen [VB3] or both, were enrolled in this study. Patients were injected locally with either a combination therapy of aminoglycoside and cephalosporin [group I, 17 patients] or pefloxacin [group II, 37 patients]. Administration of the antibiotic was performed either via a transperineal route [13 cases] or via a TRUS guided injection [41 cases] in the echogenic zone or external gland. Patients were injected once per week for 3 consecutive weeks. Patients were followed- up for a period ranged from12 to 25 months with an average of 15 months. Follow-up was lost in 8 patients. The bacteriologic cure was regarded only when the culture of both EPS andVB3 was negative.The bacteriologic cure rate was 46,7% for the combination therapy group and 67.8% for the pefloxacin group. Clinical improvement was higher than bacteriologic cure in both groups.Relapse and reinfection occurred in [53.3%] after an average of 10 months and in [31.2%] after an average of 15 months in the combination therapy and pefloxacin groups respectively. A significant difference in the success rate was observed between groups [p-value <0.05]. Few complications as perineal pain, proctalgia hematuria and hemospermia were reported. Direct antibiotic infiltration of the prostate in patients with CBP offers a new hopeful method in the treatment of this condition. Combination therapy with aminoglycoside and cephalosporin gave a satisfactory clinical and bacteriologic cure. Pefloxacin quinolone antibiotic achieved a superior result and opened a new field of medical therapy for this resistant disease