International Journal of Antimicrobial Agents 29 (2007) 549–556 Efficacy of repeated cycles of combination therapy for the eradication of infecting organisms in chronic bacterial prostatitis Vittorio Magri a , Alberto Trinchieri b , Giacomo Pozzi c , Antonella Restelli d , Maria Cristina Garlaschi d , Erminio Torresani d , Pasquale Zirpoli e , Emanuela Marras f , Gianpaolo Perletti f,∗ a Urology and Sonography Outpatient Clinic, Istituti Clinici di Perfezionamento, Milan, Italy b Urology Unit, A. Manzoni Hospital, Lecco, Italy c San Carlo Hospital, Paderno Dugnano, Italy d Microbiology Unit, Fondazione IRCCS Osp. Maggiore Policlinico Mangiagalli Regina Elena, Milan, Italy e Laboratory of Clinical Pathology, Istituti Clinici di Perfezionamento, Milan, Italy f Department of Structural and Functional Biology, Section of Pharmacology, University of Insubria, Via A. Da Giussano 12, 21052 Busto A., Varese, Italy Received 28 July 2006; accepted 16 September 2006 Abstract A total of 137 patients with a diagnosis of chronic bacterial prostatitis (CBP) were subjected to combination pharmacological therapy with antibacterial agents (ciprofloxacin/azithromycin), alpha-blockers (alfuzosin) and Serenoa repens extracts. Of those, 88 patients (64.2%) showed microbiological eradication at the completion of a 6-week cycle of therapy. Of the remaining 49 patients showing persistence of the causative organism(s) or reinfection at the end of treatment, 36 completed a second cycle of combination therapy for 6 weeks: 27 patients (75%) showed eradication of the causative organism, whereas in nine cases persistence or reinfection was observed. The cumulative eradication rate of the present study – calculated on a total of 137 enrolled patients – is 83.9%. Clinical examination showed a marked improvement of signs and symptoms linked to prostatitis. Remarkably, combination therapy could attenuate CBP symptoms prior to microbiological eradication, thus rapidly decreasing the impact of the disease on the quality of life of patients. Clinical remission was extended throughout a follow-up period of 30 months for 94% of patients, whereas seven patients showed relapse of the disease. In summary, our results indicate that about 20% of patients enrolled in this study, who were refractory to a protocol of 6-week combination therapy, could be ‘rescued’ by a second cycle of treatment. Clinical follow-up data show that combination therapy could ensure extended relief from CBP symptoms, and a general improvement in quality of life. © 2007 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved. Keywords: Chronic bacterial prostatitis; Azythromicin; Ciprofloxacin; Alfuzosin; Serenoa repens; NIH-CPSI 1. Introduction Chronic bacterial prostatitis (CBP) has been recently defined as a chronic or persistent infection of the prostate in which a pathogen can be demonstrated by a lower uri- nary tract segmented localisation test [1], but in which ∗ Corresponding author. Tel.: +39 0331 339 420; fax: +39 0331 339 459. E-mail address: gianpaolo.perletti@uninsubria.it (G. Perletti). systemic symptoms are absent [2]. Infection is generally associated with a variety of urinary symptoms, often accom- panied by pain in the pelvic region. The severity of these symptoms is usually scored by a worldwide-used index, the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), which is calculated on the basis of a questionnaire addressed to the patient [3]. Other clinical parameters may be necessary to complete the diagnosis of this complex condition, and additional analytical procedures 0924-8579/$ – see front matter © 2007 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved. doi:10.1016/j.ijantimicag.2006.09.027