Summary
The treatment of bacterial prostatitis is difficult, with a cure rate of only about 30% in various studies. The reason for the failure is the lack of diffusion of acidic and non lipid soluble antibacterials into the prostate. This possibly explains the poor effect of penicillin and sulfa compounds. The failure of sulfa to diffuse into the prostate may also explain the poor results from the use of trimethoprim-sulfa combinations. Basic fat soluble antibacterials with a high pKa concentrate well in the normal prostate but less well in the infected prostate where pH increases in the prostatic fluid have been observed. This may explain the poor effect of these substances (trimethoprim, erythromycin). Indanyl carbenicillin sodium yields higher concentrations in the prostate interstitial fluid of dogs than other penicillins, possibly due to its fat solubility, which may explain the relatively good clinical results with this compound. The finding of bacterial growth in 17% of removed prostate tissue specimens is of uncertain importance. Prostatic calculi (often present in prostatitis) contain bacteria and these may be hard, if not impossible, to eradicate.
Zusammenfassung
Die Behandlung der bakteriellen Prostatitis ist schwierig. In verschiedenen Studien wird eine Heilungsrate von nur 30% mitgeteilt. Die Mißerfolge erklären sich aus der mangelnden Diffusion von sauren und nicht lipidlöslichen antibakteriellen Substanzen in die Prostata. Diese Möglichkeit macht die geringe Wirksamkeit von Penicillin und Sulfa-Verbindungen verständlich. Die fehlende Diffusionsfähigkeit von Sulfa in die Prostata kann auch die schlechten Ergebnisse bei der Verwendung von Trimethoprim-Sulfa-Verbindungen erklären. Basische, fettlösliche antibakterielle Substanzen mit einem hohen pKa erreichen in der normalen Prostata hohe Konzentrationen, diese sind jedoch in der infizierten Prostata geringer, wobei pH-Erhöhungen in der Prostataflüssigkeit beobachtet werden. Daraus kann die Ursache für die schlechte Wirkung dieser Substanzen (Trimethoprim, Erythromycin) abgeleitet werden. Indanyl-Carbenicillin-Natrium erreicht in der interstitiellen Flüssigkeit der Prostata von Hunden höhere Konzentrationen als andere Penicilline, möglicherweise infolge seiner Fettlöslichkeit, was die relativ guten klinischen Erfolge mit dieser Verbindung erklären kann. In 17% der Gewebsproben aus resezierten Prostatae wuchsen Bakterien. Dieser Befund ist in seiner Bedeutung nicht sicher einzuordnen. Prostatasteine (die sich oft bei Prostatitis finden) enthalten Bakterien, deren Eradikation schwierig, wenn nicht unmöglich sein dürfte.
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Madsen, P.O., Nielsen, O.S. Treatment of bacterial prostatitis: Theoretical and clinical problems. Infection 8, 250–253 (1980). https://doi.org/10.1007/BF01639047
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DOI: https://doi.org/10.1007/BF01639047