Outcome of Antibiotic Therapy with Ciprofloxacin in Chronic Bacterial Prostatitis Wolfgang Weidner, 1 Martin Ludwig, 1 Elmar Brähler 2 and Hans Gerd Schiefer 3 1 Department of Urology, University of Giessen, Giessen, Germany 2 Department of Medical Psychology, University of Leipzig, Leipzig, Germany 3 Department of Medical Microbiology, University of Giessen, Giessen, Germany Abstract Chronic bacterial prostatitis (CBP) is a rare infection of the prostate with Escher- ichia coli being the predominant causative pathogen. Appropriate antimicrobial ther- apy is mandatory for cure. We report on our experience with a 4-week regimen of ciprofloxacin in 40 men suffering from CBP due to E. coli. Follow-up was conducted over a period of 12 to 24 months. The microbiological work-up included an analysis of expressed prostatic secretions (EPS) and semen. Eradication of the pathogen in EPS was achieved in 92% of patients 3 months after therapy and in about 70 to 80% of patients evaluated 12 and 24 months after treatment, respectively. Treatment failure was not associated with the presence of prostatic cal- culi, as assessed by transrectal ultrasonography. After successful therapy, mean EPS pH decreased significantly from 7.95 to 7.35. Significant bacteriospermia with E. coli was detected in 21/22 (95.5%) patients before treatment and in 6/22 (27.3%) patients 6 months after therapy. Our data reconfirm ciprofloxacin as an excellent antimicrobial agent in the therapy of CBP. However, eradication of the pathogen is unpredictable and cannot be achieved in every case. Further studies should correlate microbiological treatment success with symptomatic relief, as assessed by standardised questionnaires. REVIEW ARTICLE Drugs 1999; 58 Suppl. 2: 103-106 0012-6667/99/0002-0103/$02.00/0 © Adis International Limited. All rights reserved. Chronic bacterial prostatitis (CBP) is a rare infec- tion of the prostate gland with a high impact on symp- tomatology. About 5 to 10% of patients with symptom- atic prostatitis suffer from proven chronic bacterial prostatitis primarily due to Escherichia coli. [1] Our study group verified CBP in 46 of 656 (7%) patients attending the Giessen outpatient department for pros- tatitis. We observed 28 men with CBP due to E. coli, 8 cases due to other Gram-negative bacteria, 6 cases caused by Enterococcus faecalis and 4 by Staphylo- coccus epidermidis. [2] CBP was proven by sequential urine analysis as the determining factor using the 4- specimen-test. The presence of high numbers of bac- teria either in expressed prostatic secretions (EPS) or the urine after prostatic massage usually provides the diagnostic classification. [3] It is widely accepted that Gram-negative bacteria are the major aetiological pathogens. [1-3] Gram-positive bacteria (especially S. saprophyticus) are implicated in some cases, [4] and the role of anaerobic bacteria in disease aetiology is ques- tionable. [5] The selection of appropriate therapeutic agents re- quires a broad antibacterial spectrum, including the above-mentioned Gram-positive and Gram-negative uropathogens, and sufficient drug penetration into the inflamed prostatic fluid. [6] The class of antibiotics that appears to hold the most promise is the 5-fluoro- quinolones. [7] However, even though it appears that ‘treatment with these substances for about 4 weeks may give sufficient clinical results especially in E. coli prostatitis’, [7] a number of reasons explain why pros- tatic infections tend to be refractory to antibiotic ther- apy. One of the most important reasons may be that the infection persists as small, sporadic bacterial