Aagaard J, Madsen P O
Urology Section, University of Wisconsin, School of Medicine, Madison.
Drugs Aging. 1992 May-Jun;2(3):196-207. doi: 10.2165/00002512-199202030-00004.
Lower tract localisation studies have been the gold standard in diagnosing various kinds of prostatitis. Four clinical categories are recognised: acute and chronic bacterial prostatitis, nonbacterial prostatitis, and prostatodynia. In acute bacterial prostatitis Gram-negative bacteria are the most common pathogens isolated. The roles of Gram-positive bacteria in chronic bacterial prostatitis and of Chlamydia trachomatis in nonbacterial prostatitis are contentious. Treatment of these various forms of prostatitis has been a challenge to the clinician. The lack of penetration of various drugs into the prostatic tissue, because of poor lipid solubility, ionisation, protein binding, and unfavourable pH gradients from the plasma to the prostatic fluid, may be the main reasons for poor results. The minimum inhibitory concentration (MIC) of antibacterial drugs used, and the concentration of drugs actually obtained in the prostate, combined with the influence of pH and inoculum size, and the effect of prostatic fluid and prostatic extracts on MIC are important factors in determining at least the theoretical efficacy of various drugs in the treatment of prostatitis. The new fluoroquinolone ofloxacin, the first quinolone to be approved for the treatment of chronic bacterial prostatis, has excellent penetration into human prostate and high in vitro activity in human urine and prostatic tissue. From a theoretical standpoint, ofloxacin should be ideal in the treatment of chronic bacterial prostatis. Comparative studies have shown its superiority to carbenicillin. Several noncomparative studies have also been reported. The initial results are promising, but further investigations are needed.
下尿路定位研究一直是诊断各类前列腺炎的金标准。目前公认有四种临床类型：急性和慢性细菌性前列腺炎、非细菌性前列腺炎以及前列腺痛。在急性细菌性前列腺炎中，革兰氏阴性菌是最常见的分离病原体。革兰氏阳性菌在慢性细菌性前列腺炎中的作用以及沙眼衣原体在非细菌性前列腺炎中的作用存在争议。对这些不同类型前列腺炎的治疗一直是临床医生面临的挑战。由于脂溶性差、离子化、蛋白结合以及血浆与前列腺液之间不利的pH梯度等原因，各种药物难以穿透前列腺组织，这可能是治疗效果不佳的主要原因。所用抗菌药物的最低抑菌浓度（MIC）、在前列腺中实际获得的药物浓度，再加上pH和接种量的影响，以及前列腺液和前列腺提取物对MIC的作用，都是决定各种药物治疗前列腺炎至少理论疗效的重要因素。新型氟喹诺酮类药物氧氟沙星是首个被批准用于治疗慢性细菌性前列腺炎的喹诺酮类药物，它对人前列腺有良好的穿透力，在人尿液和前列腺组织中具有较高的体外活性。从理论角度来看，氧氟沙星在治疗慢性细菌性前列腺炎方面应该是理想的。比较研究表明它优于羧苄青霉素。也有一些非比较性研究报告。初步结果很有前景，但还需要进一步研究。
