Antibiotics are needed for inflammation of the prostate gland. If the disease is not treated, the likelihood of impotence, infertility, sclerosis, adenoma and gland abscess increases.
When and why antibiotics are needed for prostatitis
The bacterial form of the pathology is found in about 12-18% of patients. Acute process is diagnosed in 5-9 men out of 100 aged 22-45 years, chronic sluggish course - in 8-11% of patients.
The main task of antibiotic treatment is to suppress the activity of pathogenic microbes. They relieve inflammation, pain, normalize glandular functions, improve urine flow and blood circulation.
The diagnosis is based on:
- laboratory tests confirming the presence of bacteria in semen, urine, prostate secretions;
- characteristic symptoms;
- signs of inflammation, reflected in changes in the composition of urine and blood.
Important factors in choosing an antibiotic
It is impossible to say which antibiotic is the best. Bacterial inflammation in the prostate tissue is caused by many pathogens, so one drug may be effective against one type of germ and not useful against another.
Only an antibiotic selected taking into account certain factors will have a positive therapeutic effect:
- type of pathogen (determined by bacteriological analysis of the microflora);
- the sensitivity of the identified bacteria to specific antibiotics.
The causes of bacterial prostatitis can be:
- typical gram-negative pathogens Escherichia coli (Escherichia coli) and Pseudomonas aeruginosa (Pseudomonas aeruginosa) - 55-80%;
- enterobacteriaceae - 10-30%;
- fecal enterococci (Enterococcus faecalis) - 5-10%;
- atypical pathogens - chlamydia (Chlamydia) - 36%, Trichomonas - 11%;
- ureaplasma (Ureaplasma) and mycobacteria (Musoplasma) - 20%.
- rarely found pathogens - gonococci, fungi, Proteus, Klebsiella, gram-positive bacteria - staphylococci and streptococci.
To accurately identify the pathogen, bacteriological inoculation or a more informative method for DNA diagnosis - PCR (polymerase chain reaction) is performed.
When choosing a drug, consider:
- spectrum of action - the number and types of pathogens that an antibiotic can suppress;
- the ability of the drug to accumulate in the prostate gland and maintain the desired concentration;
- long-lasting antibacterial effect;
- side effects and contraindications;
- method of administration of the drug;
- manner and rate of excretion from the body;
- doses and combinations of drugs;
- the ability to combine the drug with other drugs and therapeutic methods;
- previous antibiotic treatment (onset and duration);
Groups of effective antibiotics and prescription characteristics
In order for the antibiotic to penetrate the gland easily, it must be fat-soluble, bind weakly to blood proteins and be active in an alkaline environment.
Aminopenicillins
Today, preference is given to protected penicillins, resistant to the destructive action of enzymes - β-lactamases, secreted by the coccal flora. Penicillins are more effective when combined with clavulanic acid.
This group of antibiotics works better in acute uncomplicated process and rare exacerbations of the chronic form of the disease, if typical pathogens of the pathology are identified. They do not suppress chlamydia, mycoplasma, enterobacteria.
Possible side effects:
- nausea;
- diarrhea;
- allergic rashes;
- itching;
- people with a predisposition to drug allergies may experience allergic shock.
Cephalosporins
They act on many pathogens, but not for long. Effective in acute prostatitis. They accumulate poorly in the tissue of the prostate gland, which is why in a chronic process they are used as a "shock" group with antibiotic action for a short time.
Staphylococcal flora and clostridia are resistant to cephalosporins.
The drugs are considered to be of low toxicity, and only individual intolerance to cephalosporins is considered an absolute contraindication.
If the course of the disease is severe or has recently been treated with antibiotics, they resort to the use of cephalosporins in combination with aminoglycosides.
Fluoroquinolones
They have a strong and long-lasting effect on most typical and atypical bacteria, including Pseudomonas aeruginosa (Pseudomonas aeruginosa), mycoplasma, chlamydia. Fluoroquinolones create high concentrations in prostate tissue, which is why they are considered first-line drugs for the treatment of a chronic process, except when pathogens are suspected to be resistant to them. Their effectiveness in suppressing microorganisms is 65 - 90%.
Due to the prolonged effect, fluoroquinolones are taken 1-2 times a day. Not prescribed for epilepsy, adolescent boys under 15 - 16 years. Doses are adjusted in men with heart, kidney disease, patients taking antidepressants.
Medications are usually well tolerated. In rare cases, observe:
- rash;
- itching;
- swelling of the vocal cords;
- stomach pain;
- nausea;
- diarrhea;
- insomnia;
- nervousness;
- photosensitization (sensitivity of the skin to the sun) under UV radiation.
Macrolides
The active substances accumulate in the affected prostate tissue. Macrolides are often prescribed in acute form without complications and in the chronic course of the disease. High activity of macrolides is observed in prostatitis caused by chlamydia. However, they do not suppress the typical pathogen of the pathology - Escherichia coli and atypical microorganisms - mycobacteria, clostridia, enterococci.
Side effects are rare, more common in patients with intolerance to this group of antibiotics, severe liver or kidney damage. Rare:
- nausea;
- heartburn;
- dysbiosis;
- hives;
- diarrhea.
Aminoglycosides
Gentamicin has many contraindications and often causes side effects. It is prescribed to patients with an acute course of the disease. The drug rapidly suppresses the activity of most types of pathogens, including atypical forms, fungi and mutated microbes that are insensitive to other groups of antibiotics.
In chronic bacterial prostatitis, aminoglycosides are not prescribed due to low accumulation (accumulation) in the prostate tissue. The body slowly gets used to gentamicin.
The drug is contraindicated for:
- increased reaction to aminoglycosides;
- severe renal dysfunction;
- Do not lie;
- parkinsonism;
- hearing impairment;
- dehydration.
Nausea, anemia, epilepsy, drowsiness and impaired renal function may occur.
Anzamicins
They have a wide range of action against microbes. The drugs are chosen if the prostatitis is severe, with tuberculous mycobacteria (Koch's bacillus) - mycobacterium tuberculosis.
Tetracyclines
They have high natural activity against chlamydial and mycoplasmal prostatitis. They accumulate in high concentrations in the tissues of the body. Fecal enterococci do not respond to tetracycline treatment.
They are now rarely prescribed due to their high toxicity, ability to penetrate sperm and affect male reproductive cells. After the end of therapy, 3-4 months should pass before conception.
Side effects: intestinal disorders, nausea, deterioration of liver function, allergic reactions, candidiasis.
Combination treatment
If the prostatitis is caused by Trichomonas, ureaplasma, mycobacteria, a combined treatment regimen is developed. It provides a combination of several groups of drugs.
Local treatment
Suppositories for bacterial inflammation in the prostate are prescribed to increase the effectiveness of the treatment. The use of antibiotic suppositories has the following advantages:
- rapid penetration of glandular tissue through the intestinal wall;
- maximum accumulation of the drug in the gland;
- minimal side effects, as the drug is concentrated in the tissues, almost without penetrating the general bloodstream;
- low doses;
- small number of contraindications, easy application.
The indications for the use of antibacterial suppositories are similar to those for other dosage forms - tablets, capsules, injections.
Suppositories contain less antibiotic than tablets and solutions, so the course of their use is longer.
List of commonly prescribed suppositories:
- Suppositories with framycetin (aminoglycosides).
- Suppositories with erythromycin (macrolides).
- Chloramphenicol suppositories (active ingredient - chloramphenicol).
- Suppositories with rifampicin are effective, which quickly penetrate the gland and destroy most microbes. In tuberculous prostatitis, treatment lasts 6-9 weeks.
General principles of application
At home you should follow the principles of using antimicrobial drugs.
- Follow exactly the prescribed dosages, follow the regimen and therapeutic regimen if a combination of drugs is prescribed.
- The course of therapy must be completed. If you interrupt the flow of drugs into the prostate tissue, then the acute process will quickly become chronic. The remaining microorganisms will continue to act "underground" and will develop antibiotic resistance.
- The standard duration of treatment is at least 8-12 days in the acute period and up to 6 weeks in the chronic period.
- If in the acute phase, after 3 days of treatment, the pain and temperature do not decrease, you should see a doctor.
The treatment regimen for prostatitis is developed taking into account many factors. An antibiotic that works for one patient may not work for another.