The role of quinolones in the treatment of chronic bacterial prostatitis.

Chronic bacterial prostatitis is a rare infection but difficult to treat. Usually co-trimoxazole has been used, yet with poor results. Because of their favorable pharmacokinetics and their broad antibacterial spectrum, the newer quinolones may be a good alternative. In contrast to beta-lactam antibiotics their concentrations in prostatic fluid, in prostatic tissue and in seminal fluid are relatively high in comparison to the corresponding plasma concentrations. For prostatic fluid measurements, however, possible urinary contamination has to be considered and identified otherwise falsely high levels are measured. A total of 23 studies with the newer quinolones (norfloxacin, ciprofloxacin, ofloxacin, pefloxacin, enoxacin, temafloxacin and rufloxacin) in the treatment of chronic bacterial prostatitis are available. However, the results of these studies are difficult to compare because not all investigators used the same diagnostic criteria and there was a considerable range of duration of treatment and of follow-up. Since the issue involved in the treatment of prostatitis is that of relapse, patients cannot be considered cured if they have been followed for one week or one month only. There were four studies among the 23 publications, i.e. one with norfloxacin and three with ciprofloxacin, which fulfilled the criteria of standardized prostatic localization and of long-term follow-up of at least six months. The results are promising, but further investigations, especially controlled studies, are needed in order to determine the role of the newer quinolones in the treatment of chronic bacterial prostatitis.