Antibiotics are needed for inflammation of the prostate gland. If the disease is not treated, the likelihood of impotence, infertility, sclerosis, adenoma and glandular abscesses increases.
When and why antibiotics are needed for prostatitis
The bacterial form of the pathology is found in about 12-18% of patients. An acute process is diagnosed in 5-9 out of 100 men at the age of 22-45, a chronic slow course - in 8-11% of patients.
The main task of antibiotic treatment is to suppress the activity of pathogenic microbes. Relieves inflammation, pain, normalizes gland functions, improves urine flow and blood circulation.
Diagnosis is based on:
- laboratory tests that confirm the presence of bacteria in semen, urine, prostate secretions;
- characteristic symptoms;
- signs of inflammation, which are 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 prostate tissue is caused by many disease-causing organisms, so a drug can be effective against one type of germ and not useful against another.
Only one antibiotic, selected taking into account some factors, will have a positive therapeutic effect:
- type of pathogen (determined by bacteriological analysis of microflora);
- the sensitivity of the identified bacteria to specific antibiotics.
The causative agents of bacterial prostatitis can be:
- typical gram-negative pathogens Escherichia coli (Escherichia coli) and Pseudomonas aeruginosa (Pseudomonas aeruginosa) - 55-80%;
- Enterobacteriaceae (Enterobacteriaceae) - 10-30%;
- fecal enterococci (Enterococcus faecalis) - 5-10%;
- atypical pathogens - chlamydia (Chlamydia) - 36%, Trichomonas - 11%;
- ureaplasma (Ureaplasma) and mycobacteria (Musoplasma) - 20%.
- rarely detected pathogens - gonococci, fungi, Proteus, Klebsiella, gram-positive bacteria - staphylococci and streptococci.
To accurately identify the pathogen, bacteriological inoculation or a more informative method of DNA diagnostics, PCR (polymerase chain reaction) is performed.
When choosing a drug, take into account:
- spectrum of action: the number and types of pathogens that a specific antibiotic can suppress;
- the ability of a medicinal substance to accumulate in the prostate gland and maintain the desired concentration;
- long-term antibacterial effect;
- adverse reactions and contraindications;
- method of drug administration;
- route and speed 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 (beginning and duration);
Effective antibiotic groups and prescribing features
In order for the antibiotic to easily penetrate the gland, it must be fat-soluble, weakly bind 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 - b-lactamases, secreted by the coccal flora. Penicillins are most effective when combined with clavulanic acid.
This group of antibiotics works best in an uncomplicated acute process and rare exacerbations of a chronic form of the disease, if the pathogens typical of the pathology are identified. They do not suppress chlamydia, mycoplasma, enterobacteria.
Possible side reactions:
- nausea;
- diarrhea;
- allergic rashes;
- itch;
- People with a tendency to drug allergies can experience allergic shock.
Cephalosporins
They act on many pathogens, but not for long. Effective for acute prostatitis. They accumulate poorly in the tissue of the prostate gland, therefore, in a chronic process, they are used as a "shock" group of antibiotic action for a short time.
Staphylococcal flora and clostridia are resistant to cephalosporins.
The drugs are considered to be of low toxicity; only individual intolerance to cephalosporins is indicated as absolute contraindications.
If the course of the disease is severe, or has recently been treated with antibiotics, the use of cephalosporins in combination with aminoglycosides is used.
Fluoroquinolones
They have a strong and long-term effect on most typical and atypical bacteria, including Pseudomonas Aeruginosa (Pseudomonas aeruginosa), mycoplasma, chlamydia. Fluoroquinolones create a high concentration in the prostate tissue, therefore, they are considered first-line drugs for the treatment of a chronic process, except in cases where pathogens are suspected to be resistant to them. Their effectiveness in the suppression of 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 receiving antidepressants.
Medicines are generally well tolerated. In rare cases, observe:
- rash;
- itch;
- swelling of the vocal cords;
- stomach ache;
- nausea;
- diarrhea;
- insomnia;
- nervousness;
- photosensitization (sensitivity of the skin to the sun) under UV radiation.
macrolides
The active ingredients accumulate in the affected prostate tissue. Macrolides are often prescribed in the acute form without complications and in the chronic course of the disease. High macrolide activity 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.
Adverse reactions are rare, more often in patients with intolerance to this group of antibiotics, severe liver or kidney damage. Rarely occur:
- nausea;
- stomach ache;
- dysbiosis;
- urticaria;
- diarrhea.
Aminoglycosides
Gentamicin has many contraindications and often causes side reactions. 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, mutated fungi and microbes that are insensitive to other groups of antibiotics.
In the chronic course of bacterial prostatitis, aminoglycosides are not prescribed due to low accumulation (accumulation) in the prostate tissue. The body slowly gets used to gentamicin.
The remedy is contraindicated for:
- increased reaction to aminoglycosides;
- severe renal dysfunction;
- Do not lie;
- parkinsonism;
- hearing problem;
- dehydration.
Nausea, anemia, epilepsy, somnolence, and impaired renal function may occur.
ansamycins
They have a broad spectrum of action against microbes. Drugs are chosen if prostatitis is severe, with tuberculous mycobacterium (Koch's bacillus) - mycobacterium tuberculosis.
Tetracyclines
They have a high natural activity against chlamydial and mycoplasma prostatitis. They accumulate in high concentration in the tissues of the organ. Fecal enterococcus does not respond to tetracyclines treatment.
Now they are 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.
Adverse reactions: intestinal disorders, nausea, deterioration of liver function, allergic reactions, candidiasis.
Combined treatment
If prostatitis is caused by Trichomonas, ureaplasma, mycobacteria, a combined treatment regimen is developing. It involves a combination of several drug groups.
Local treatment
Suppositories for bacterial inflammation in the prostate are prescribed to increase the effectiveness of treatment. The administration of antibiotic suppositories has the following advantages:
- rapid penetration into the gland tissue through the intestinal wall;
- maximum accumulation of the medicinal substance in the gland;
- a minimum of side reactions, as the drug is concentrated in the tissues, almost without penetrating the general bloodstream;
- low dosages;
- small number of contraindications, easy application.
Indications for the use of antibacterial suppositories are similar to those for other medicinal 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).
- Suppositories from chloramphenicol (active ingredient - chloramphenicol).
- Suppositories with rifampicin are effective, which quickly penetrate the gland and destroy most of the microbes. In the case of tuberculous prostatitis, the treatment lasts 6-9 weeks.
General principles of application
At home, it is necessary to follow the principles of the use of antimicrobial drugs.
- Accurately adhere to the prescribed dosages, adhere to the regimen and therapeutic regimen, if a combination of drugs is prescribed.
- The course of therapy must be completed completely. If you stop the flow of medicinal substances into the prostate tissue, the acute process will quickly turn into chronic. The remaining microorganisms will continue to act "underground" and develop resistance to antibiotics.
- The standard duration of treatment is at least 8-12 days in the acute period and up to 6 weeks in the chronic.
- If in the acute phase, after 3 days of treatment, the pain and temperature do not decrease, it is necessary to go to the doctor's appointment.
The treatment regimen for prostatitis is developed taking into account many factors. An antibiotic that works for one patient may not work for another.