慢性前列腺炎的抗生素应用（英文ppt）use of antibiotics in chronic prostatitis syndromes课件

UseofAntibioticsinChronicProstatitisSyndromes DanielShoskesMD MSc FRCS C ClevelandClinicFlorida EpidemiologyofChronicProstatitis Estimatedprevalence8 14 MehikAetalBJUInt2000 86 4 443Upto50 ofmentreatedforsymptomsofprostatitisatleastonceinlifeSicknessimpactequivalenttoMI Crohn soranginaWenningerKetalJUrol1996 155 3 965 MentalQOLimpactequivalenttoseverediabetes NIHClassificationofProstatitis CategoryIAcuteBacterialProstatitisCategoryIIChronicBacterialProstatitisCategoryIIIChronicPelvicPainSyndromeCategoryIVAsymptomaticInflammation CategoryIIProstatitis NocontroversyrecurrentUTI uropathogen EPSpositivebetweenattacksSomecontroversynoUTI uropathogenlocalizedtoEPSMuchcontroversynon uropathogenlocalizedtoEPSroleofStaph Strep anaerobes yeast biofilm CultureofEPSandSemen 202patientsinNIHstudyhad4glasstest semen culturedfor2and5daysSignificantproportionofculturesnegativeat2dayswerepositiveat5days 2 5 VB114 6 VB26 9 EPS23 3 VB39 3 andsemen20 StrepandCorynebacteriafoundinallsamplesStaphandE coliONLYEPS VB3andSemen3of7positiveE coliculturesinstudywere2 5 63 ofEPSand52 ofsemen2 5 wereabsentinVB1orVB2 AntibioticSelectioninProstatitis highpKa lipidsolubleprimaryconcernforgram ve enterococcussecondaryconcernforgram ve chlamydia anaerobesquinolones macrolides tetracyclines sulphasnitrofurantoindoesNOTpenetrateprostate CiproforE coliChronicProstatitis 40men Ciprofor4weeksEPSsterilizedin 92 at3months70 at12months80 at24monthsfailuresnotassociatedwithcalculinosymptomoutcomemeasureWeidneretal Drugs58 103 1999 AdjuvantstoAntibioticsinCategoryIIProstatitis CombinationwithalphablockersBarbaliasGAetalJUrol1998 159 3 883 CombinationwithprostaticmassageShoskesDA ZeitlinSI ProstateCancerandProstateDiseases1999 2 3 159Longterm lowdosesuppressivetherapy Quinolones NewvsOld moxifloxacin Avelox gatifloxacin Tequin superiorfor Grampositiveenterococcusanaerobespossiblychlamydia mycoplasma ciprofloxacin Cipro ofloxacin Floxin superiorfor E coliProteusPseudomonas AntibioticsforCPPS Mostcommontherapyforchronicprostatitisdespitenorandomized placebocontrolledstudiesBeliefthatallprostatitisisduetoinfectiondifficulttoculturebacteriabiofilm 16SrRNAinCPPS Krieger 1996 signalseenin77 ofbiopsiesfrommenwithCPPSKeay 1999 signalseenin88 ofbiopsiesfrommenwithCaPHochreiter 2000 0 28cadavericorgandonorshadbacterialsignalTanner 1999 signalseenin65 ofEPSsamplesfrommenwithCPPSPredominanceofCorynebacterialformsincludingnewlydiscoveredbacteria RoleofAntibioticsinCP CPPS Multicenterstudyof102patientswithprostatitis II IIIaandIIIb RecentUTIexcluded12weeksofofloxacinregardlessofcategory 57 feltmoderatetomarkedimprovementnodifferenceinresponsebycategory antibodystatusorWBCcountNohelpifnoimprovementby4weeks WhyMightAntibioticsHelpCPPS Allprostatitisisbacterialwhymostpatientsfail whynoimprovementafterRPwhyimmunosuppressionhelps Antibioticshavedirectanti inflammatoryeffectsquinolones macrolidesandtetracyclinesblockIL 6andIL 8Intracellularpathogensnotdetectedchlamydia E coliPlaceboeffect Conclusions AntibioticshavedefiniteroleforcategoryIIchronicprostatitisManypatientswithcategoryIIIwillrespondbutmechanismunclearCompellingevidencethatsomewithnon uropathogenshaveinfectionbutmanydon tBacteriologiccurenotequivalenttocureProspectiverandomizedplacebocontrolledtrialshouldhelpsettlein2002 CCFDiagnosticProtocol Offantibioticsforatleast2weeksHistory Physical NIH CPSIUroflow ultrasoundbladderresidualUrethralswab EPS semenBacterialculturesfor5daysPostejaculatorypainorrecurrentcategoryII TRUSCystoforhematuriaorsuspectedstrictureHydrodistensionifsuspectIC CCFTreatmentProtocol CategoryIIantibiotics massage