Skip to main content

Fluoroquinolone antimicrobial agents in the treatment of prostatitis and recurrent urinary tract infections in men


Chronic bacterial prostatitis is the most frequent cause for recurrent urinary tract infection in young and middle-aged men. The selection of an appropriate antimicrobial agent that has optimal pharmacokinetics for urine and prostatic secretion and tissue is important in both entities. Fluoroquinolones possess several pharmacologic characteristics that favor them for treatment of urinary tract infection and prostatitis. The pharmacokinetics of fluoroquinolones and the theoretical background of drug penetration into the prostate are outlined. Analyzing the concentrations of various fluoroquinolones in urine, prostatic and seminal fluid, and in prostatic tissue, it becomes obvious that the fluoroquinolones differ in plasma concentrations and in their concentrations at these sites. Nevertheless, overall, the concentrations at the site of infection of most of the fluoroquinolones should be sufficient for the treatment of chronic bacterial prostatitis and vesiculitis and recurrent urinary tract infection in men caused by susceptible pathogens.

This is a preview of subscription content, access via your institution.

References and Recommended Reading

  1. 1.

    Drilica K, Zhao X: DNA gyrase, topoisomerase IV, and the 4-quinolones. Microbiol Mol Biol Rev 1997, 61:377–392.

    Google Scholar 

  2. 2.

    Ehrlich-Gesellschaft P, Naber KG, Adam D: Classification of fluoroquinolones. Int J Antimicrob Agents 1998, 10:255–257.

    Article  Google Scholar 

  3. 3.

    Naber KG: Which fluoroquinolones are suitable for the treatment of urinary tract infections? Int J Antimicrob Agents 2001, 17:331–341.

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Schaeffer AJ. Prostatitis: US perspective. Int J Antimicrob Agents 1999, 11:205–211.

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Workshop Committee of the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK): Chronic Prostatitis Workshop. Bethesda, MD: December 7–8, 1995.

  6. 6.

    Naber KG, Bergman B, Bishop MC, et al.: EAU Guidelines on Urinary and Male Genital Tract Infections. Njimegen, The Netherlands: European Association of Urology; 2001:1–75. Guidelines of the European Association of Urology on urinary and male genital tract infections. Concise statement about the treatment options.

    Google Scholar 

  7. 7.

    Meares EM, Stamey TA: Bacteriologic localization patterns in bacterial prostatitis and urethritis. Invest Urol 1968, 5:492–518.

    PubMed  CAS  Google Scholar 

  8. 8.

    Krieger JN, Berger RE, Ross SO, et al.: Seminal fluid findings in men with nonbacterial prostatitis and prostatodynia. J Androl 1996, 17:310–318.

    PubMed  CAS  Google Scholar 

  9. 9.

    Weidner W, Jantos C, Schiefer HG, et al.: Semen parameters in men with and without proven chronic prostatitis. Arch Androl 1991, 26:173–183.

    PubMed  CAS  Google Scholar 

  10. 10.

    Weidner W, Schiefer HG, Krauss H, et al.: Chronic prostatitis: a thorough search for etiologically involved microorganisms in 1461 patients. Infection 1991, 19(Suppl 3):119–125.

    Article  Google Scholar 

  11. 11.

    Naber KG, Weidner W. Prostatitis, epididymitis, and orchitis. In Infectious Diseases. Edited by Armstrong D, Cohen J. London: Mosby; 1999:1–58.

    Google Scholar 

  12. 12.

    Stamey TA, Meares EM, Winningham G: Chronic bacterial prostatitis and the diffusion of drugs into the prostatic fluid. J Urol 1970, 103:187–194.

    PubMed  CAS  Google Scholar 

  13. 13.

    Stamey TA: Urinary infection in males. In Urinary Infections. Baltimore: Williams and Wilkins; 1972:161.

    Google Scholar 

  14. 14.

    Madsen PO, Whalen PR: Interaction between antimicrobial agents and prostatic tissue extract and fluid. Infection 1978, 6:75–77.

    Article  CAS  Google Scholar 

  15. 15.

    Stamey TA, Bushby SR, Bragonje J: The concentration of trimethoprim in prostatic fluid: non-ionic diffusion or active transport? J Infect Dis 1973, 129Suppl:686–690.

    Google Scholar 

  16. 16.

    Madsen PO, Kjaer TB, Baumeller A: Prostatic tissue and fluid concentrations of trimethoprim and sulfamethoxazole: experimental and clinical studies. Urology 1976, 8:129–132.

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Gasser TC, Larsen EH, Dorflinger T, Madsen PO: The influence of various body fluids and pH on E. coli MIC of quinolone derivatives. In Therapy of Prostatitis: Experimental and Clinical Data. Edited by Weidner W. Munich: Zuckschwerdt; 1986:50–53.

    Google Scholar 

  18. 18.

    Sörgel F, Bulitta J, Kinzig-Schippers M: Pharmakokinetik der Chinolone. Chemotherapie J 2002, 11:25–33.

    Google Scholar 

  19. 19.

    Naber KG, Kinzig M, Sörgel F, Weigel D: Penetration of ofloxacin into prostatic fluid, ejaculate, and seminal fluid. Infection 1993, 21:34–39.

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Naber KG, Sörgel F, Kinzig M, Weigel DM: Penetration of ciprofloxacin into prostatic fluid, ejaculate and seminal fluid in volunteers after an oral dose of 750 mg. J Urol 1993, 150:1718–1721.

    PubMed  CAS  Google Scholar 

  21. 21.

    Naber KG: Role of quinolones in treatment of chronic bacterial prostatitis. In Quinolone Antimicrobial Agents, edn 2. Edited by Hooper DC, Wofson JS. Washington DC: American Society of Microbiology; 1993:285–297.

    Google Scholar 

  22. 22.

    Naber CK, Steghafner M, Kinzig-Schippers M, et al.: Concentrations of gatifloxacin in plasma and urine and penetration into prostatic and seminal fluid, ejaculate, and sperm cells after single oral administration of 400 milligrams to volunteers. Antimicr Agents Chemother 2001, 45:293–297.

    Article  CAS  Google Scholar 

  23. 23.

    Sörgel F, Kinzig, Naber KG: Physiological disposition of macrolides. In Macrolides: Chemistry, Pharmacology, and Clinical Uses. Edited by Bryskier AJ, Butzler JP, Neu HC, Tulkens PM. Paris: Arnette Blackwell; 1993:421–431.

    Google Scholar 

  24. 24.

    Meares EM Jr: Prostatitis: a review. Urol Clin North Am 1975, 2:3–27.

    Google Scholar 

  25. 25.

    Fair WR, Cordonnier JJ: The pH of prostatic fluid: a reappraisal and therapeutic implication. J Urol 1978, 120:695–698.

    PubMed  CAS  Google Scholar 

  26. 26.

    Anderson RU, Fair WR: Physical and chemical determinations of prostatic secretion in benign hyperplasia, prostatitis, and adenocarcinoma. Invest Urol 1976, 14:137–140.

    PubMed  CAS  Google Scholar 

  27. 27.

    Blacklock NJ, Beavis JP: The response of fluid pH in inflammation. Br J Urol 1978, 46:537–542.

    Google Scholar 

  28. 28.

    Pfau A, Perlberg S, Shapiro A: The pH of the prostatic fluid in health and disease: implications of treatment in chronic bacterial prostatitis. J Urol 1978, 119:384–387.

    PubMed  CAS  Google Scholar 

  29. 29.

    Naber KG, Madsen PO: Antibiotics: basic concepts. In Textbook of Prostatitis. Edited by Nickel JC. Oxford: Isis Medical Media; 1999:83–94. Review about pharmacokinetic concepts of antibiotics in prostatitis and summary of the most important clinical studies regarding treatment of chronic bacterial prostatitis.

    Google Scholar 

  30. 30.

    Bulitta J, Kinzig-Schippers M, Naber CK, et al.: Limitations in the use of drug cocktails (DC) to compare the pharmacokinetics (PK) of drugs: ciprofloxacin (CIP) vs Levofloxacin (LEV). Poster presented at the 40th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC). Toronto: September 17–20, 2000.

  31. 31.

    Png JC, Tan E, Foo KT, et al.: A comparative study of the distribution of ofloxacin and ciprofloxacin in prostatic tissue after simultaneous oral ingestion. Br J Urol 1997, 79:781–784.

    PubMed  CAS  Google Scholar 

  32. 32.

    Park H, Lee T, Lee J, et al.: Simultaneous determination of levofloxacin and ciprofloxacin concentrations in serum and prostatic tissue [abstract #3291]. Presented at the 20th International Congress of Chemotherapy. Sydney: June 29-July 3, 1997.

  33. 33.

    Naber KG, Giamarellou H: Proposed study design in prostatitis. Infection 1994, 22:59–60.

    Article  Google Scholar 

  34. 34.

    Schaeffer AJ, Darras FS: The efficacy of norfloxacin in the treatment of chronic bacterial prostatitis refractory to trimethoprim-sulfamethoxazole and/or carbenicillin. J Urol 1990, 144:690–693.

    PubMed  CAS  Google Scholar 

  35. 35.

    Petrikkos G, Peppas T, Giamarellou H, et al.: Four-year experience with norfloxacin in the treatment of chronic bacterial prostatitis [Abstract #1302]. Presented at the 17th International Congress of Chemotherapy. Berlin: June 27, 1991.

  36. 36.

    Pust RA, Ackenheil-Koppe HR, Gilbert P, Weidner W: Clinical efficacy of ofloxacin (Tarivid) in patients with chronic bacterial prostatitis: preliminary results. J Chemother 1989, 1:469–471.

    Google Scholar 

  37. 37.

    Weidner W, Schiefer HG, Dalhoff A: Treatment of chronic bacterial prostatitis with ciprofloxacin: results of a 1-year followup study. Am J Med 1987, 82:280–283.

    PubMed  CAS  Google Scholar 

  38. 38.

    Weidner W, Schiefer HG, Brahler E: Refractory chronic bacterial prostatitis: a re-evaluation of ciprofloxacin treatment after a median follow-up of 30 months. J Urol 1991, 146:350–352.

    PubMed  CAS  Google Scholar 

  39. 39.

    Pfau A: Therapie der unteren Harnwegsinfektionen beim Mann unter besonderer Berücksichtigung der chronischen bakteriellen Prostatitis. Akt Urol 1987, 18:31–33.

    Article  Google Scholar 

  40. 40.

    Pfau A: The treatment of chronic bacterial prostatitis. Infection 1991, 19:160–164.

    Article  Google Scholar 

  41. 41.

    Naber KG, Busch W, Focht J, the German Prostatitis Study Group: Ciprofloxacin in the treatment of chronic bacterial prostatitis: a prospective, non-comparative, multicentre clinical trial with long-term follow-up. Int J Antimicrob Agents 2000; 14:143–149.

    PubMed  Article  CAS  Google Scholar 

  42. 42.

    Naber KG, the European Lomefloxacin Prostatitis Study Group: Lomefloxacin versus ciprofloxacin in the treatment of chronic bacterial prostatitis. Int J Antimicrob Agents 2002, 20:18–27.

    PubMed  Article  CAS  Google Scholar 

  43. 43.

    Litwin MS, McNaughton-Collins M, Fowler FJ Jr, et al.: National Institutes of Health Chronic Prostatitis Symptom Index: development and validation of new outcome measure. J Urol 1999, 162:369–375.

    PubMed  Article  CAS  Google Scholar 

  44. 44.

    Naber KG: Antibiotic treatment of chronic bacterial prostatitis. In Textbook of Prostatitis. Edited by Nickel JC. Oxford: Isis Medical Media; 1999:285–292.

    Google Scholar 

  45. 45.

    Bjerklund Johansen TE, Grüneberg RN, Guibert J, et al.: The role of antibiotics in the treatment of chronic prostatitis: a consensus statement. Eur Urol 1998, 34:457–466.

    Article  Google Scholar 

  46. 46.

    Mayersak JS: Transurethral ultrasonography directed intraprostatic injection of gentamycin-xylocaine in the management of the benign painful prostate syndrome: a report of a 5-year clinical study of 75 patients. Int Surg 1998, 83:347–349.

    PubMed  CAS  Google Scholar 

  47. 47.

    Jimenez Cruz JF, Boronat F, Gallego J: Treatment of chronic prostatitis: intraprostatic injection under echography control. J Urol 1988, 139:967–970.

    Google Scholar 

  48. 48.

    De la Rosette JJ, Hubregste MR, Meuleman EJH, et al.: Diagnosis and treatment of 409 patients with prostatitis syndromes. Urology 1993, 41:301–307.

    PubMed  Article  Google Scholar 

  49. 49.

    Ohkawa M, Yamaguchi K, Tokunaga S, et al.: Antimicrobial treatment for chronic prostatitis as a means of defining the role of Ureaplasma urealyticum. Urol Int 1993, 51:129–132.

    PubMed  CAS  Article  Google Scholar 

  50. 50.

    Vorland LH, Carlson K, Aalen O: An epidemiological survey of urinary tract infections among outpatients in Northern Norway. Scand J Infect Dis 1985, 17:277–283.

    PubMed  CAS  Google Scholar 

  51. 51.

    Barnes RC, Daifuku R, Roddy RE, Stamm WE: Urinary tract infection in sexually active homosexual men. Lancet 1986, 1:171–173.

    PubMed  Article  CAS  Google Scholar 

  52. 52.

    Spach DH, Stapelton AE, Stamm WE: Lack of circumcision increases the risk of urinary tract infection in young men. JAMA 1992, 267:679–681.

    PubMed  Article  CAS  Google Scholar 

  53. 53.

    Krieger JN, Ross SO, Simson JM: Urinary tract infections in healthy university men. J Urol 1993, 149:1046–1048.

    PubMed  CAS  Google Scholar 

  54. 54.

    Ulleryd P, Zackrisson B, Aus G, et al.: Selective urological evaluation in men with febrile urinary tract infection. BJU Int 2001, 88:15–20.

    PubMed  Article  CAS  Google Scholar 

  55. 55.

    Hoepelman AI, van Buren M, van den Broeck J, Borleffs JC: Bacteriuria in men infected with HIV-1 is related to their immune status (CD4+ cell count). AIDS 1992, 6:179–184.

    PubMed  Article  CAS  Google Scholar 

  56. 56.

    Smith JW, Jones SR, Reed WP, et al.: Recurrent urinary tract infections in men. Ann Intern Med 1979, 91:544–548.

    PubMed  CAS  Google Scholar 

  57. 57.

    Sabbaj J, Hoagland VL, Cook T: Norfloxacin versus co-trimoxazole in the treatment of recurring urinary tract infections in men. Scand J Infect Dis 1986, 48:48–53.

    CAS  Google Scholar 

  58. 58.

    Lipsky BA: Urinary tract infection in men: epidemiology, pathophysiology, diagnosis, and treatment. Ann Intern Med 1989, 110:138–150.

    PubMed  CAS  Google Scholar 

  59. 59.

    Ulleryd P, Zackrisson B, Aus G, et al.: Prostatic involvement in men with febrile urinary tract infection as measured by serum prostate-specific antigen and transrectal ultrasonography. BJU Int 1999, 84:470–474.

    PubMed  Article  CAS  Google Scholar 

  60. 60.

    Blacklock NJ: The anatomy of the prostate: relationship with prostatic infection. Infection 1991, 19(Suppl 3):S111-S114.

    PubMed  Article  Google Scholar 

  61. 61.

    Gleckman R, Crowely M, Natsios GA: Recurrent urinary tract infections in men: an assessment of contemporary treatment. Am J Med Sci 1980, 279:31–36.

    PubMed  CAS  Article  Google Scholar 

  62. 62.

    Schaeffer AJ: Review of norfloxacin in complicated and recurrent urinary tract infections. In Symposium: New Insights into the Clinical Profile of Norfloxacin. Taormina, Italy: May 23, 1988.

  63. 63.

    Ulleryd P, Sandberg T: Ciprofloxacin for 2 or 4 weeks in the treatment of febrile urinary tract infection in men: a randomized trial with a 1-year follow-up. Scand J Infect Dis 2003, 35:34–39.

    PubMed  Article  Google Scholar 

  64. 64.

    Biering-Sorensen F, Hoiby N, Nordenbo A, et al.: Ciprofloxacin as prophylaxis for urinary tract infections: prospective, randomized, cross-over, placebo-controlled study in patients with spinal cord lesion. J Urol 1994, 151:105–108.

    PubMed  CAS  Google Scholar 

  65. 65.

    Van der Wall E, Verkooyen RP, Mintjes-De Groot J, et al.: Prophylactic ciprofloxacin for catheter-associated urinary tract infection. Lancet 1992, 339:946–951.

    PubMed  Article  Google Scholar 

  66. 66.

    Paul-Ehrlich-Gesellschaft für Chemotherapie e.V: PEG Resistenzstudie 2001. ag_resistenz/main.html. Accessed 2002.

  67. 67.

    Madsen PO, Kjaer TB, Baumueller A: Prostatic tissue and fluid concentration of trimethoprim and sulfamethoxazole. Urology 1976, 8:129–132.

    PubMed  Article  CAS  Google Scholar 

  68. 68.

    Nickel JC, Olson ME, Costerton JW: Rat model of experimental bacterial prostatitis. Infection 1991, 19:126–130.

    Article  Google Scholar 

Download references

Author information



Rights and permissions

Reprints and Permissions

About this article

Cite this article

Wagenlehner, F.M.E., Naber, K.G. Fluoroquinolone antimicrobial agents in the treatment of prostatitis and recurrent urinary tract infections in men. Curr Infect Dis Rep 7, 9–16 (2005).

Download citation


  • Norfloxacin
  • Prostatitis
  • Gatifloxacin
  • Enoxacin
  • Seminal Fluid