Bacterial prostatitis: new methods of treatment.

Four different clinical categories of prostatitis are recognized at present: acute bacterial prostatitis, chronic bacterial prostatitis, nonbacterial prostatitis, and prostatodynia. Treatment results of chronic bacterial prostatitis have, in the past, been rather poor. In addition to local factors (e.g., prostatic calculi), the poor results may well be due, in part, to lack of penetration of the various drugs used into the prostatic tissue and fluid, mostly because of unfavorable lipid solubility, degree of ionization, protein binding, and unfavorable pH gradients from the plasma to prostatic fluid. All of these factors determine the diffusion of a drug into prostatic tissue and fluid. The minimum inhibitory concentrations (MIC) of the various drugs used and the concentration of the drugs actually obtained in the prostate, combined with the influence of pH, inoculum size, and effect of prostatic fluid and prostatic extract on MIC, are important factors in determining at least the theoretical efficacy of various drugs in the treatment of chronic bacterial prostatitis. The new fluoroquinolones have excellent penetration into both animal and human prostates and very low MIC for the infecting organisms and should, from a theoretical standpoint, be ideal in the treatment of chronic bacterial prostatitis. Few clinical studies have been done, and only prospective, randomized clinical trials will determine the relative efficacy of the various quinolones in the treatment of chronic bacterial prostatitis.