Treatment of recurrent chronic bacterial prostatitis by local injection of thiamphenicol into prostate

Twenty-nine patients were treated for recurrent chronic bacterial prostatitis by an injection of 2 Gm. thiamphenicol glycinate via the perineal route directly into the prostate. Escherichia coli was identified as the pathogen responsible for this infection in 83 per cent of the cases. Using this medication locally, cure was obtained in 66 per cent of the patients. Thiamphenicol levels in prostatic fluid varied between 1 and 4,000 micrograms./ml. and were unrelated to the time after intraprostatic administration. However, in most cases they were high enough to inhibit most strains of gram-negative bacilli responsible for prostatitis. Serum levels were correlated with the time after injection and decreased over twenty-four-hour observation from 25 to 0.3 micrograms./ml. The pH of the prostatic fluid measured in 24 patients varied from 7.1 to 8.7 with a mean value of 7.9 and was markedly higher than the pH value of 6.5 reported for men without inflammatory prostatic disease. The elevated pH of prostatic fluid could explain the failure of short-term trimethoprim/sulfamethoxazole (Co-trimoxazole) treatment in our patients. The cure rate of the localized thiamphenicol treatment was higher than was reported with short- and long-term trimethoprim/sulfamethoxazole therapy. We concluded that direct injection into the prostate offers a good alternative for treatment of more resistant chronic infections of the prostate.