Treatment of bacterial prostatitis: Theoretical and clinical problems

Abstract

The treatment of bacterial prostatitis is difficult, with a cure rate of only about 30% in various studies. The reason for the failure is the lack of diffusion of acidic and non lipid soluble antibacterials into the prostate. This possibly explains the poor effect of penicillin and sulfa compounds. The failure of sulfa to diffuse into the prostate may also explain the poor results from the use of trimethoprim-sulfa combinations. Basic fat soluble antibacterials with a high pKa concentrate well in the normal prostate but less well in the infected prostate where pH increases in the prostatic fluid have been observed. This may explain the poor effect of these substances (trimethoprim, erythromycin). Indanyl carbenicillin sodium yields higher concentrations in the prostate interstitial fluid of dogs than other penicillins, possibly due to its fat solubility, which may explain the relatively good clinical results with this compound. The finding of bacterial growth in 17% of removed prostate tissue specimens is of uncertain importance. Prostatic calculi (often present in prostatitis) contain bacteria and these may be hard, if not impossible, to eradicate.