Comparison of the Efficacy of Antibiotic Monotherapy and Antibiotic Plus Alpha-blocker Combination Therapy for Patients with Inflammatory Chronic Prostatitis/Chronic Pelvic Pain Syndrome

Chul Woong Youn; Kyung-Chul Son; Hyang-Sik Choi; Dong Deuk Kwon; Kwangsung Park; Soo Bang Ryu

doi:10.4111/kju.2008.49.1.72

Journal List > Korean J Urol > v.49(1) > 1005166

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Youn, Son, Choi, Kwon, Park, and Ryu: Comparison of the Efficacy of Antibiotic Monotherapy and Antibiotic Plus Alpha-blocker Combination Therapy for Patients with Inflammatory Chronic Prostatitis/Chronic Pelvic Pain Syndrome

Original Article

Korean Journal of Urology

Korean Journal of Urology 2008; 49(1): 72-76.

Published online: 31 January 2008

DOI: https://doi.org/10.4111/kju.2008.49.1.72

Comparison of the Efficacy of Antibiotic Monotherapy and Antibiotic Plus Alpha-blocker Combination Therapy for Patients with Inflammatory Chronic Prostatitis/Chronic Pelvic Pain Syndrome

Chul Woong Youn, Kyung-Chul Son, Hyang-Sik Choi, Dong Deuk Kwon, Kwangsung Park

, Soo Bang Ryu

Department of Urology, Chonnam National University Medical School, Gwangju, Korea.

sbryu@chonnam.ac.kr

Received 25 July 2007 Accepted 5 November 2007

Abstract

Purpose

The objectives of this study was to compare the efficacy of antibiotic monotherapy with antibiotic plus alpha-blocker combination therapy for the treatment of inflammatory chronic pelvic pain syndrome (CPPS) patients.

Materials and Methods

Between October 2005 and May 2006, 69 patients who were diagnosed as CPPS (National Institutes of Health; NIH-catagory IIIa), were included in this study. The patients were randomly placed into two groups: group I was treated with gatifloxacin alone (35 patients), and group II was treated with gatifloxacin and doxazosin (34 patients) for 6 weeks. For all the patients, the urinalysis, expressed prostatic massage, the National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) and a distal rectal examination (DRE) were performed at the initial visit. The NIH-CPSI was compared both before and after the treatment.

Results

On the initial diagnosis, the mean CPSI of the group I patients was 24.0±6.3, and that for the group II patients was 24.7±6.9. After the treatment, that of the group I was 16.6±5.4, and that of group II was 13.4±5.3. After 6 weeks of treatment, the changes in the total CPSI scores had significantly improved in group II compared with group I (p<0.05). A statistically significant improvement occurred in the pain score, the voiding symptom score and the quality of life in the group II compared with group I (p<0.05)

Conclusions

This study suggests that combination therapy of antibiotic plus alpha-blocker would be more effective than antibiotic monotheraphy for treating patients with inflammatory chronic prostatitis/chronic pelvic pain syndrome.

Keywords: Prostatitis, Pelvic pain, Adrenergic alpha-blockers, Antibiotics

Figures and Tables

Table 1

Patients' characteristics

^*NIH-CPSI: National Institute of Health-Chronic Prostatitis Symptom Index, ^†Mean±SD, Group I: antibiotic alone, Group II: antibiotic plus alpha-blocker

Table 2

Results of the NIH-CPSI^* for the two groups

^*NIH-CPSI: National Institute of Health-Chronic Prostatitis Symptom Index, ^†Tx: treatment, ^‡Mean±SD, Group I: antibiotic alone, Group II: antibiotic plus alpha-blocker

Table 3

Results of the EPS^* for the two groups

^*EPS grade 0: <5 white blood cells/high-power field (WBC/HPF), grade 1: 5-9 WBC/HPF, grade 2: 10-29 WBC/HPF, grade 3: 30-49 WBC/HPF, grade 4: 50-99 WBC/HPF, grade 5: ≥100 WBC/HPF, EPS: expressed prostate secretion, ^†Tx: treatment

References

1. Roberts RO, Lieber MM, Rhodes T, Girman CJ, Bostwick DG, Jacobsen SJ. Prevalence of a physician-assigned diagnosis of prostatitis: the Olmsted County Study of Urinary Symptoms and Health Status Among Men. Urology. 1998. 51:578–584.

2. Collins MM, Stafford RS, O'Leary MP, Barry MJ. Distinguishing chronic prostatitis and benign prostatic hyperplasia symptoms: results of a national survey of physician visits. Urology. 1999. 53:921–925.

3. Krieger JN, Nyberg L, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA. 1999. 282:236–237.

4. Shoskes DA, Hakim L, Ghoniem G, Jackson CL. Long-term results of multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome. J Urol. 2003. 169:1406–1410.

5. Nickel JC, Nyberg LM, Hennenfent M. Research guidelines for chronic prostatitis: consensus report from the first National Institutes of Health International Prostatitis Collaborative Network. Urology. 1999. 54:229–233.

6. Kirby RS, Lowe D, Bultitude MI, Shuttleworth KE. Intraprostatic urinary reflux: an aetiological factor in abacterial prostatitis. Br J Urol. 1982. 54:729–731.

7. Hellstrom WJ, Schmidt RA, Lue TF, Tanagho EA. Neuromuscular dysfunction in nonbacterial prostatitis. Urology. 1987. 30:183–188.

8. Nickel JC. The three as of chronic prostatitis therapy: antibiotics, alpha-blockers and anti-inflammatories. What is the evidence? BJU Int. 2004. 94:1230–1233.

9. Curtis Nickel J, Baranowski AP, Pontari M, Berger RE, Tripp DA. Management of men diagnosed with chronic prostatitis/chronic pelvic pain syndrome who have failed traditional management. Rev Urol. 2007. 9:63–72.

10. Cho IR. Evaluation and treatment of patients with prostatitis. Korean J Androl. 2005. 23:1–11.

11. Litwin MS, McNaughton-Collins M, Fowler FJ, Nickel JC, Calhoun EA, Pontari MA, et al. The National Institutes of Health chronic prostatitis symptom index: development and validation of a new outcome measure. Chronic Prostatitis Collaborative Research Network. J Urol. 1999. 162:369–375.

12. Donker PJ, Ivanovici F, Noach EL. Analyses of the urethral pressure profile by means of electromyography and the administration of drugs. Br J Urol. 1972. 44:180–193.

13. Barbalias GA. Prostatodynia or painful male urethral syndrome? Urology. 1990. 36:146–153.

14. Lee SW, Liong ML, Yuen KH, Liong YV, Krieger JN. Chronic prostatitis/chronic pelvic pain syndrome: role of alpha blocker therapy. Urol Int. 2007. 78:97–105.

15. Barbalias GA, Nikiforidis G, Liatsikos EN. Alpha-blockers for the treatment of chronic prostatitis in combination with antibiotics. J Urol. 1998. 159:883–887.

16. Mehik A, Alas P, Nickel JC, Sarpola A, Helstrom PJ. Alfuzosin treatment for chronic prostatitis/chronic pelvic pain syndrome: a prospective, randomized, double-blind, placebo-controlled, pilot study. Urology. 2003. 62:425–429.

17. Cheah PY, Liong ML, Yuen KH, Teh CL, Khor T, Yang JR, et al. Terazosin therapy for chronic prostatitis/chronic pelvic pain syndrome: a randomized, placebo controlled trial. J Urol. 2003. 169:592–596.

18. Jung YH, Kim JG, Cho IR. The efficacy of terazosin in the management of chronic pelvic pain syndrome (CPPS): comparison between category IIIa and IIIb. Korean J Urol. 2006. 47:1191–1196.

19. Ryu YG, Kim HJ, Park HJ. The efficacy of alfuzosin for chronic prostatitis/chronic pelvic pain syndrome in young and middle aged patients. Korean J Urol. 2007. 48:858–862.

20. Nickel JC, Narayan P, McKay J, Doyle C. Treatment of chronic prostatitis/chronic pelvic pain syndrome with tamsulosin: a randomized double blind trial. J Urol. 2004. 171:1594–1597.

21. Neal DE, Moon TD. Use of terazosin in prostatodynia and validation of a symptom score questionnaire. Urology. 1994. 43:460–465.

22. Alexander RB, Propert KJ, Schaeffer AJ, Landis JR, Nickel JC, O'Leary MP, et al. Ciprofloxacin or tamsulosin in men with chronic prostatitis/chronic pelvic pain syndrome: a randomized, double-blind trial. Ann Intern Med. 2004. 141:581–589.

23. Mo KI, Lee KS, Kim DG. Efficacy of combination therapy for patients with chronic prostatitis/chronic pelvic pain syndrome: a prospective study. Korean J Urol. 2006. 47:536–540.

24. Osborn DE, George NJ, Rao PN, Barnard RJ, Reading C, Marklow C, et al. Prostatodynia--physiological characteristics and rational management with muscle relaxants. Br J Urol. 1981. 53:621–623.

25. Evliyaoglu Y, Burgut R. Lower urinary tract symptoms, pain and quality of life assessment in chronic non-bacterial prostatitis patients treated with alpha-blocking agent doxazosin; versus placebo. Int Urol Nephrol. 2002. 34:351–356.

26. Nickel JC, Downey J, Johnston B, Clark J. Canadian Prostatitis Research Group. Predictors of patient response to antibiotic therapy for the chronic prostatitis/chronic pelvic pain syndrome: a prospective multicenter clinical trial. J Urol. 2001. 165:1539–1544.

27. Goto T, Makinose S, Ohi Y, Yamauchi D, Kayajima T, Nagayama K, et al. Diffusion of piperacillin, cefotiam, minocycline, amikacin and ofloxacin into the prostate. Int J Urol. 1998. 5:243–246.

TOOLS

ORCID iDs: Kwangsung Park
https://orcid.org/http://orcid.org/0000-0001-8827-162X
Similar articles