Antimicrobial treatment of prostatitis

The aim of this review is to emphasize the role of antimicrobial treatment in prostatitis. Especially in chronic bacterial prostatitis, the selection of an appropriate antimicrobial agent with optimal pharmacokinetics for prostatic secretion and tissue is important. The theoretical background of drug penetration into the prostate is outlined, emphasizing the phenomenon of ion-trapping and the role of nonionic diffusion of weak acids, bases and amphoteric drugs across biological membranes with a pH gradient. Determination of drug concentrations in human prostatic secretion are problematic because of possible urinary contamination. Studies have been carried out mainly in healthy volunteers. The results have to be interpreted with caution, if not care was taken to rule out or at least identify urinary contamination. Analyzing the concentrations of various fluoroquinolones in prostatic and seminal fluid as well as in prostatic tissue, it becomes obvious that the fluoroquinolones differ not only in plasma concentrations but also in their penetration ability to these sites. In spite of intensive investigations, our knowledge is still limited concerning the mechanisms that govern the transport of antibiotic drugs into and their activity in the various prostatic compartments and how the findings can be applied clinically. Nevertheless, overall the concentrations at the site of infection of most of the fluoroquinolones with this indication should be sufficient for the treatment of chronic bacterial prostatitis and vesiculitis caused by susceptible pathogens.