Antibiotic therapy has to overcome the blood/prostate barrier that prevents many antibiotics from reaching levels that are higher than minimum inhibitory concentration. A blood-prostate barrier restricts cell and molecular movement across the rat ventral prostate epithelium. Treatment requires prolonged courses (4–8 weeks) of antibiotics that penetrate the prostate well. The fluoroquinolones, tetracyclines and macrolides have the best penetration. There have been contradictory findings regarding the penetrability of nitrofurantoin , quinolones (ciprofloxacin, levofloxacin), sulfas (Bactrim, Septra), doxycycline and macrolides (erythromycin, clarithromycin). This is particularly true for gram-positive infections. In a review of multiple studies, levofloxacin was found to reach prostatic fluid concentrations 5.5 times higher than ciprofloxacin, indicating a greater ability to penetrate the prostate. Clinical success rates with oral antibiotics can reach 70% to 90% at 6 months, although trials comparing them with placebo or no treatment do not exist. Persistent infections may be helped in 80% of patients by the use of alpha blockers (tamsulosin, alfuzosin), or long term low dose antibiotic therapy. Recurrent infections may be caused by inefficient urination (benign prostatic hypertrophy, neurogenic bladder), prostatic stones or a structural abnormality that acts as a reservoir for infection. In theory, the ability of some strains of<unk> to form biofilms might be one of the factors that facilitate development of<unk> . Bacteriophages hold promise as another potential treatment for<unk> . The addition of prostate massage to courses of antibiotics was previously proposed as being beneficial and prostate massage may mechanically break up the biofilm and enhance the drainage of the prostate gland. However, in more recent trials, this was not shown to improve outcome compared to antibiotics alone.
Chronic bacterial prostatitis
Acute prostatitis
Granulomatous prostatitis
Asymptomatic inflammatory prostatitis
Benign prostatic hyperplasia
Interstitial cystitis
Urethral cancer
Urinary bladder disease