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Although erythromycin was introduced into clinical medicine more than 28 years ago, the indications for its use continue to expand. This antibiotic has emerged as appropriate therapy for Legionnaires' disease, chronic bacterial prostatitis caused by Escherichia coli, Klebsiella pneumoniae, and Proteus species, enteritis and colitis produced by Campylobacter fetus, and soft tissue and pleuropulmonary anaerobic infections in which Bacteroides fragilis plays no role. In combination with an aminoglycoside, erythromycin has proven to be effective for perioperative antibiotic prophylaxis in patients undergoing elective colon surgery. Additional therapeutic indications continue to be explored. The renewed interest in erythromycin has resulted in a closer examination of its potential for toxicity. New untoward events attributed to erythromycin administration have been described. This antibiotic has produced both reversible hearing loss and pseudomembranous colitis. Erythromycin also possesses the ability to inhibit the degradation of theophylline.

A prospective study was performed on 30 men with asymptomatic, recurrent urinary tract infections in order to assess contemporary treatment of this disease. Patients had to have significant bacteriuria with a pure culture of Pseudomonas aeruginosa or a member of the Enterobacteriaceae family that was susceptible in vitro to the antimicrobial agent prescribed, and a urinary sediment that demonstrated a positive antibody-coated bacteria immunofluorescence test of at least 2+ intensity. All patients were subjected to excretory urograms. Therapeutic response was appraised in accordance with previously issued FDA protocol guidelines. Colonial morphology, biochemical tests, antimicrobial susceptibility testing and serotyping of the E coli isolates and pyocin typing of Pseudomonas aeruginosa were the methods used to differentiate bacterial relapse, a measure of drug ineptitude, from reinfection, a measure of inadequate host defenses. Sterility of the urine for a minimum of six weeks after therapy developed in only 29% of the patients who could complete the two-week course of therapy. Bacterial relapse, the prevalent form of recurrence, could not be explained by the isolation of cell wall-defective bacteria, rapid emergence of resistant mutants or inadequately treated chronic bacterial prostatitis. The customary practice of prescribing a two-week course of therapy to men with recurrent, invasive urinary tract infections falls far short of the desired treatment goal.

Acute bacterial prostatitis caused by common urinary tract pathogens is an infrequent disease, and diagnostic difficulties are rarely encountered. On the other hand, chronic prostatitis is a common disease requiring rather elaborate diagnostic procedures. We applied the localization protocol of the four-specimen technique and combined quantitative determinations of microorganisms and quantitative cytologic analysis plus, in chlamydial infections, serologic investigations. Our studies provide good evidence that Ureaplasma urealyticum and Chlamydia trachomatis must be considered etiologic agents in many cases of chronic bacterial prostatitis. These unconventional microorganisms are assumed to infect the prostate by way of intracanalicular ascension from the urethra.

Chronic prostatitis is ill-understood, difficult to diagnose and often unresponsive to treatment. To clarify some of the diagnostic difficulties 135 patients and 28 control subjects were prospectively studied. Patients with chronic bacterial prostatitis, chronic non-bacterial prostatitis and recurrent non-specific urethritis (NSU) without prostatitis resembled each other in demographic characteristics. Patients with prostatodynia were more often married and born abroad. Symptoms were more common in prostatodynia but diagnosis of prostatitis and prostatodynia depended on examination of the expressed prostatic secretion (EPS) for leucocytes and microorganisms. An inflammatory response in the EPS was found in both forms of prostatitis but not in the other conditions. Leucocyte counts of the EPS appeared to be more sensitive than simple microscopic estimation. The EPS leucocyte figures support a previous finding that the upper limit of normal for the EPS count is around 500 cells per mm3 by the method used. The pathogenic micro-organisms cultured from the EPS of the patients with chronic bacterial prostatitis were the usual urinary pathogens reported by others. For reasons which are not clear, saprophytic organisms were more common in chronic non-bacterial prostatitis than in the other groups. While the demographic differences and increased symptoms in patients with prostatodynia will not help in diagnosis, there may be a relationship with emotional stress and this should be considered in the management of these patients.

In 1968, Meares and Stamey stated that, in the absence of any other pathology, chronic persistence of Gram-negative entero-bacteria in the prostate is the commonest cause of relapsing urinary tract infections in males. In the same year, Winningham, Nemoy and Stamey (1968) showed that most of the antibacterial drugs, which are effective in urinary tract infections, are ineffective in curing infections of the prostate gland because of the difficulty with which they cross the epithelial membrane of this gland. The same study suggested that an effective antibacterial drug, able to cross the barrier of the prostatic epithelial membrane and reach therapeutic concentrations in the prostate, should be a lipid soluble base with a high pKa and active against Gram-negative bacteria at the prostatic pH. Trimethoprim was presented as such a drug, effective in chronic bacterial prostatitis (Reeves and Ghilchik, 1970; Carroll et al., 1971). Only a few well-documented cases of chronic bacterial prostatitis have been publishedto date (Meares and Stamey, 1968; Stamey, 1972; Meares, 1973; Meares, 1975). The purpose of this paper is to describe our experience with this entity and to discuss its clinical and therapeutic aspects.

Most patients with prostatitis suffer from a wide variety of signs and symptoms, which render diagnosis difficult and treatment often unsuccessful [1, 2, 3, 4, 5, 6]. It has generally been accepted that prostatitis may include inflammatory reactions of the prostatic urethra (urethra posterior) and the seminal vesicles. Thus designations like prostato-vesiculitis, urethro-prostatitis and urethro-prostato-vesiculitis reflect the difficulties in separating the inflammatory response of the gland itself from similar reactions of organs in its close proximity. The former designation ‘adnexitis’ is obsolete, because inflammatory reactions of the anterior part of the urethra with discharge and especially epididymitis can be clearly separated from prostatitis, clinically as well as by laboratory tests.

Constant infusion experiments with amifloxacin, a quinoline carboxylic acid derivative, were performed in five anesthetized dogs to determine the drug concentrations in prostatic secretion (PS), prostatic interstitial fluid (PIF), prostatic tissue, and plasma (P). The experiments were carried out under steady-state conditions. Amifloxacin concentrations in PS and PIF were lower than the corresponding P concentrations, as might be expected for an acid compound. There was no significant difference between the PS/P and PIF/P concentration ratios of the drug, and none exceeded 1.0. The concentrations of amifloxacin in PS, PIF, and prostatic tissue were above the minimal inhibitory concentration values of most gram-positive bacteria causing chronic bacterial prostatitis. Clinical trials of amifloxacin seem justified.

We used an indirect solid phase radioimmunoassay to detect and quantitate immunoglobulin A (IgA) in male genital secretions with specificity for Escherichia coli (E. coli) antigen. We assayed the seminal fluid and expressed prostatic secretion (EPS) of a patient with chronic bacterial prostatitis (CBP) due to an 01 E. coli, the seminal fluid of 24 fertile men, and the seminal fluid of 62 men of infertile marriages. IgA directed apparently against the 0-antigen of the infecting E. coli was measurable in both the seminal fluid and EPS of the CBP patient. IgA in these specimens also bound to antigen in a mix of 8 common E. coli 0-serotypes that included an 01 E. coli. IgA with specificity for antigen in the mix of common E. coli 0-serotypes could not be detected in the seminal fluid of the fertile men or the men of infertile marriages. These data suggest that subclinical E. coli infections of the male reproductive tract are not commonly associated with infertility.

Sulphamethoxazole and trimethoprim concentrations were measured in 19 enucleated human prostate glands. Good concentrations of sulphamethoxazole were found after 4 days of treatment: the ratio of plasma concentration to that of prostate varied from 1-25 to 3-29. The trimethoprim concentrations were 2 to 3 times higher in the prostate than in the plasma. These high concentrations were reached very rapidly after the first dose of trimethoprim. The results are compared with date from the literature. The combination sulphamethoxazole-trimethoprim should be of value in the treatment of bacterial prostatitis.

The pH of expressed prostatic secretion was measured in men with and without inflammatory prostatic disease. Whereas the pH of expressed prostatic secretion was acid with a mean of 6.7 in men without inflammatory prostatic disease, it reached a mean of 8.1 in those with chronic bacterial prostatitis. Return of expressed prostatic secretion to acid values after cure of the disease occurred after at least 2 years.The implications are discussed of the elevation of the expressed prostatic secretion pH in chronic bacterial prostatitis on its effective treatment. The markedly alkaline pH of expressed prostatic secretion in chronic bacterial prostatitis is the probable cause of the ineffectiveness of the short-term cotrimoxazole treatment and the only partial success of the more effective longterm treatment in this disease. In the presence of such a pH the aminoglycosides are recommended as an additional effective antimicrobial drug in cases of chronic bacterial prostatitis not responding to cotrimoxazol...

Human seminal plasma and canine prostatic fluid have a potent bactericidal effect. The compound responsible for the activity, the prostatic antibacterial factor (PAF), purified approximately 5000-fold by ion-exchange chromatography on a Dowex 50WX2 H + resin, is a heat stable, water soluble, low molecular weight cationic substance. About 90% of the organisms commonly responsible for human urinary tract infections are sensitive to this antibacterial agent. Preliminary results indicate that PAF may play an important role as a defense mechanism in humans. PAF activity was demonstrated in the seminal plasma of 34 human controls tested. In 6 patients with chronic bacterial prostatitis PAF activity was either absent or markedly reduced.

Introduction Chronic recurrent bacterial prostatitis (HRBP) affects the reproductive function and negatively affects the quality of life of men. The multifactorial pathogenesis of this disease causes the failure of antibiotic therapy and some cases, requires an in-depth study of the mechanisms of disease development and additional treatment methods. Objectives of the study: to study of the effectiveness of immunoactive therapy (recombinant interferon alpha-2b with an antioxidant complex) in combination with antibacterial therapy in patients with HRBP. Materials and methods Prospective trial: examination and treatment of 62 patients. Two groups: I (study) group (n=31) received antibacterial therapy (ABT) and a therapy with recombinant IFN Alpha-2b based medication with antioxidant complex (vitamins E and C), II (control) group (n=31) received only ABT. The examination plan included questionnaires (NIH - CPSI, IPSS, Hamilton), general blood and urine tests, biochemical blood tests, urethral scrapings for PCR diagnostics, plasma testosterone, native, electron microscopy, culture test and immunoferment analysis of the prostate sercet, uroflowmetry, Transrectal ultrasonography (TRUS). Results When monitoring the clinical picture according to questionnaires (IPSS, NIH-CPSI, Hamilton scale) and laboratory indicators, 1 month after treatment, a significant reduction in symptoms was observed in both groups, and after 3, 6, and 12 months - in patients of group I. Conclusions The Combination of an antibacterial drug and recombinant interferon alpha-2b in the treatment of HRBP provides more effective relief of the infectious and inflammatory process in the long term than antibacterial monotherapy.

Ninety-six patients with chronic bacterial prostatitis (CBP) and evidence of infection were randomized to receive a 4-week oral course of either prulifloxacin (a new fluoroquinolone) 600 mg or levofloxacin 500 mg once daily. They were evaluated with the Meares-Stamey test and the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) at baseline and one week after therapy completion. Patients with microbiological eradication were evaluated again with the Meares-Stamey test 6 months after therapy completion. The microbiological eradication rate was 72.73% for prulifloxacin and 71.11% for levofloxacin (p=0.86) and the reduction in the NIH-CPSI was 10.75 and 10.73, respectively (p=0.98). Safety was comparable, with 18.18% adverse events for prulifloxacin and 22.22% for levofloxacin (p=0.79). Thus, a 4-week course of prulifloxacin 600 mg once daily is at least as effective and safe as levofloxacin 500 mg once daily in the treatment of CBP.

Prostatitis is a common genitourinary disease in men. The National Institutes of Health has defined four types of prostatitis. The bacteriology of acute and chronic bacterial prostatitis is well understood. Causative organisms can be isolated by four-glass urine cultures. Chronic pelvic pain syndrome (CPPS; chronic abacterial prostatitis) is an enigma; whether there is a microbiologic cause for this condition is unknown. Researchers have postulated that CPPS may be an infectious disease of the prostate. This article reviews current literature regarding the microbiology of the prostate in CPPS.

The results of comparative trials of fluoroquinolones for the treatment of uncomplicated and complicated urinary tract infections (UTI) were reviewed. Several randomized, comparative trials showed that in uncomplicated UTI norfloxacin, ciprofloxacin, and ofloxacin were at least as effective as trimethoprim-sulfamethoxazole (TMP-SMZ) and amoxicillin and usually more effective than nalidixic acid, pipemidic acid, and nitrofurantoin. Comparative trials of single-dose regimens have, however, been limited. A few randomized, comparative trials have shown that in complicated UTI norfloxacin, ciprofloxacin, and ofloxacin were at least as effective as amoxicillin and TMP-SMZ and usually more effective than pipemidic acid. Moreover, preliminary results indicate that fluoroquinolones might be effective for the oral treatment of complicated UTI that are difficult to treat, especially those due to Pseudomonas aeruginosa. Comparative trials are needed to establish the value of fluoroquinolones for chronic bacterial prostatitis. There are no conclusive data on fluoroquinolone treatment of UTI in patients with renal failure. Emergence of resistant pathogens during therapy with fluoroquinolones has been infrequent but might be more frequent in complicated UTI caused by P. aeruginosa.

Doxycycline was administered orally to 23 patients scheduled for prostatectomy or radical cystectomy. Blood and prostatic tissue samples were collected simultaneously during operation and subsequently assayed for doxycycline levels. The concentration of doxycycline in the prostatic tissue was on average 2.75 mug/g which is far above the therapeutic level. The lowest level recorded was 0.85 mug and the highest was 4.81 mug. The findings suggest a tendency for this antibiotic to accumulate in prostatic tissue. This is in agreement with the clinical observations of the good effect of doxycycline treatment in patients with chronic bacterial prostatitis.

A new type of silicone rubber catheter with two balloons and four channels is introduced for the treatment of chronic bacterial prostatitis. Through this specially conceived catheter, a drug can be instilled in the posterior urethra, the two balloons blocking the drug from passing either into the bladder or the membranous urethra. Treatment has been applied in 212 cases of chronic bacterial prostatitis with very good results.

To the Editor.— The article by Donald O. Schiffman (231:635, 1975) describes the new antibacterial combination drug, trimethoprim-sulfamethoxazole (Bactrim, Septra) and in passing cites its usefulness in the therapy of prostatitis. If physicians are to use trimethoprim-sulfamethoxazole in treating prostatitis, we feel compelled to share our observations regarding the use of this drug in treating chronic bacterial prostatitis. In general, two major types of chronic prostatitis are clinically recognized today: chronic bacterial prostatitis, where a specific bacterial pathogen can be identified by proper culture techniques, and nonbacterial prostatitis, where no pathogen can be isolated. 1 The latter condition is the more common of the two types, is not associated with bacteriuria, and does not respond to antibacterial therapy, including trimethoprim-sulfamethoxazole. Chronic bacterial prostatitis, however, is probably the most common cause of relapsing urinary tract infection in men. 2 Since the treatment of the two conditions is entirely different, bacteriologic localization

SEVERAL conditions have been invoked to explain the persistence of urinary tract infection with a single organism: (1) infection stones, (2) chronic bacterial prostatitis, (3) abnormality of the urinary tract with patient susceptibility to infections.1The following case report illustrates the unexpected development of persistent urinary infection by the incorporation of bacteria into a preexisting renal calculus, and the use of bacterial localization studies to confirm this phenomenon. Report of a Case A 50-year-old man was first seen at the urology clinic in 1969 with gross, painless hematuria and intermittent, mild, leftsided flank pain of several months' duration. Thirty years earlier, he had undergone a left-sided pyelolithotomy. The following year he underwent a right-sided pyelolithotomy. He had been well urologically since that time. In 1968 he began to note occasional midepigastric pain. Results of a gastrointestinal work-up were normal, but kidneys, ureters, and urinary bladder (KUB) x-ray film showed

Chronic bacterial prostatitis, caused primarily by gram-negative bacteria, is a common cause of relapsing urinary tract infection. "Prostatosis," a common condition, is characterized by symptoms that simulate chronic bacterial prostatitis but the urine is sterile and the prostatic fluid cultures are negative. Historical and bacteriological data from 21 consecutive patients with chronic bacterial prostatitis were compared to similar data from 20 consecutive patients with prostatosis. Despite culture of the urethra, midstream urine, and expressed prostatic secretions for neisserial organisms, T-strain Mycoplasma organisms, aerobic bacteria, and anaerobic bacteria, no infectious agent was isolated in cases of prostatosis. Treatment of the two conditions is quite different.