Urology and Sonography Secondary Care Clinic, Azienda Ospedaliera Istituti Clinici di Perfezionamento, Milano 20132, Italy.
Asian J Androl. 2011 Nov;13(6):819-27. doi: 10.1038/aja.2011.36. Epub 2011 Jul 18.
We previously demonstrated the safety and efficacy of fluoroquinolone-macrolide combination therapy in category II chronic bacterial prostatitis (CBP). The aim of this study is to retrospectively compare the microbiological and clinical findings of two treatment schemes for CBP based on the combination of azithromycin (500 mg, thrice-weekly) with a once-daily 500- or 750-mg dose of ciprofloxacin (Cipro-500 or Cipro-750 cohort, respectively). Combined administration of azithromycin (1500 mg week(-1)) with ciprofloxacin at the rate of 750 mg day(-1) for 4 weeks rather than at 500 mg day(-1) for 6 weeks increased the eradication rates from 62.35% to 77.32% and the total bacteriological success from 71.76% to 85.57%. A significant decrease in pain and voiding signs/symptoms and a significant reduction in inflammatory leukocyte counts and serum prostate-specific antigen (PSA) were sustained throughout an 18-month follow-up period in both groups. Ejaculatory pain, haemospermia and premature ejaculation were significantly attenuated on microbiological eradication in both groups, but the latter subsided more promptly in the Cipro-750 cohort. In total, 59 Cipro-750 patients showed mild-to-severe erectile dysfunction (ED) at baseline, while 22 patients had no ED on microbiological eradication and throughout the follow-up period. In conclusion fluoroquinolone-macrolide therapy resulted in pathogen eradication and CBP symptom attenuation, including pain, voiding disturbances and sexual dysfunction. A once-daily 750-mg dose of ciprofloxacin for 4 weeks showed enhanced eradication rates and lower inflammatory white blood cell counts compared to the 500-mg dose for 6 weeks. Our results are open to further prospective validation.
我们之前已经证明了氟喹诺酮-大环内酯类联合疗法在 II 型慢性细菌性前列腺炎（CBP）中的安全性和有效性。本研究旨在回顾性比较两种治疗方案在 CBP 中的微生物学和临床发现，这两种方案是基于阿奇霉素（500mg，每周三次）与环丙沙星（Cipro-500 或 Cipro-750 队列，分别为每日 500 或 750mg 剂量）的联合使用。与每天 500mg 持续 6 周相比，每周 1500mg 阿奇霉素联合每天 750mg 环丙沙星 4 周治疗方案可将清除率从 62.35%提高到 77.32%，总细菌学成功率从 71.76%提高到 85.57%。在两组中，疼痛和排尿症状的显著改善以及炎症白细胞计数和血清前列腺特异性抗原（PSA）的显著降低，在 18 个月的随访期间持续存在。在两组中，微生物学清除后射精疼痛、血精和早泄均显著减轻，但 Cipro-750 队列中后者消退更快。共有 59 名 Cipro-750 患者在基线时有轻度至重度勃起功能障碍（ED），而 22 名患者在微生物学清除后和整个随访期间没有 ED。总之，氟喹诺酮-大环内酯类治疗可导致病原体清除和 CBP 症状缓解，包括疼痛、排尿障碍和性功能障碍。与 6 周的 500mg 剂量相比，4 周的每日 750mg 剂量的环丙沙星具有更高的清除率和更低的炎症白细胞计数。我们的结果有待进一步前瞻性验证。
