Bjerklund Johansen T E, Grüneberg R N, Guibert J, Hofstetter A, Lobel B, Naber K G, Palou Redorta J, van Cangh P J
Section of Urology, Norwegian Institute of Urology, University of Tromso, Porsgrunn, Norway.
Eur Urol. 1998 Dec;34(6):457-66. doi: 10.1159/000019784.
Practical guidelines for the diagnosis and treatment of chronic prostatitis are presented. Chronic prostatitis is classified as chronic bacterial prostatitis (culture-positive) and chronic inflammatory prostatitis (culture-negative). If chronic bacterial prostatitis is suspected, based on relevant symptoms or recurrent UTIs, underlying urological conditions should be excluded by the following tests: rectal examination, midstream urine culture and residual urine. The diagnosis should be confirmed by the Meares and Stamey technique. Antibiotic therapy is recommended for acute exacerbations of chronic prostatitis, chronic bacterial prostatitis and chronic inflammatory prostatitis, if there is clinical, bacteriological or supporting immunological evidence of prostate infection. Unless a patient presents with fever, antibiotic treatment should not be initiated immediately except in cases of acute prostatitis or acute episodes in a patient with chronic bacterial prostatitis. The work-up, with the appropriate investigations should be done first, within a reasonable time period which, preferably, should not be longer than 1 week. During this period, nonspecific treatment, such as appropriate analgesia to relieve symptoms, should be given. The minimum duration of antibiotic treatment should be 2-4 weeks. If there is no improvement in symptoms, treatment should be stopped and reconsidered. However, if there is improvement, it should be continued for at least a further 2-4 weeks to achieve clinical cure and, hopefully, eradication of the causative pathogen. Antibiotic treatment should not be given for 6-8 weeks without an appraisal of its effectiveness. Currently used antibiotics are reviewed. Of these, the fluoroquinolones ofloxacin and ciprofloxacin are recommended because of their favourable antibacterial spectrum and pharmacokinetic profile. A number of clinical trials are recommended and a standard study design is proposed to help resolve some outstanding issues.
本文介绍了慢性前列腺炎诊断和治疗的实用指南。慢性前列腺炎分为慢性细菌性前列腺炎（培养阳性）和慢性炎症性前列腺炎（培养阴性）。如果根据相关症状或复发性尿路感染怀疑为慢性细菌性前列腺炎，应通过以下检查排除潜在的泌尿系统疾病：直肠指检、中段尿培养和残余尿检查。诊断应通过Meares和Stamey技术予以确认。对于慢性前列腺炎急性加重、慢性细菌性前列腺炎和慢性炎症性前列腺炎，如果有前列腺感染的临床、细菌学或支持性免疫学证据，建议使用抗生素治疗。除非患者出现发热，否则除急性前列腺炎或慢性细菌性前列腺炎患者的急性发作外，不应立即开始抗生素治疗。应首先在合理的时间段内（最好不超过1周）进行适当的检查评估。在此期间，应给予非特异性治疗，如适当的镇痛以缓解症状。抗生素治疗的最短持续时间应为2 - 4周。如果症状没有改善，应停止治疗并重新考虑。然而，如果症状有所改善，则应至少再持续治疗2 - 4周以实现临床治愈，并有望根除致病病原体。抗生素治疗不应在未评估其有效性的情况下持续6 - 8周。文中对目前使用的抗生素进行了综述。其中，推荐氧氟沙星和环丙沙星这两种氟喹诺酮类药物，因其具有良好的抗菌谱和药代动力学特征。建议开展多项临床试验，并提出标准的研究设计以帮助解决一些悬而未决的问题。
