Antibiotic for Chronic Pelvic Pain Syndrome

Conventionally, antibiotic was only used in culture-positive bacterial prostatitis. However, multicenter clinical investigation shows that many urologists treat most prostatitis patients with antibiotics without considering the results of bacterial culture or microscopic examination (even if these examinations have been done).

Nickel et al. found that after 12 weeks of treatment with quinolones, the symptomatic remission rate of chronic prostatitis (type II and type III) was about 45% - 60%. Although these patients were divided into type Ⅱ, Ⅲ A, and Ⅲ B prostatitis before treatment, there was no statistical difference in the degree of improvement of symptoms or the number of patients with significant improvement of symptoms between these three types.

There are three possible reasons why antibiotics can improve all types of prostatitis:

First, it has a strong placebo effect;

Second, long-term antibiotic treatment may remove the invading microorganisms that are considered nonpathogenic or cannot be cultured by traditional methods, including chlamydia, mycoplasma, coagulase-negative staphylococcus, diphtheria like bacilli, Corynebacterium or bacterial aggregates hidden in prostate ducts;

Third, antibiotics may have beneficial effects in addition to killing bacterial pathogens. Prostatitis is related to the increase of cytokines, suggesting that there is an immune response and/or inflammatory response.

Antibiotics, especially quinolones, can affect the effect of cytokines: ciprofloxacin can regulate the expression of IL-6 and IL-8, while levofloxacin can also regulate the production of cytokines independently from the effect of antibiotics.

Antibiotics can also reduce the level of cytokines detected in EPS of patients with chronic prostatitis, and antibiotics at least have a relative analgesic effect in animal experiments.

Sulfonamides, tetracyclines (such as minocycline), quinolones, macrolides (such as azithromycin, erythromycin), and other antibiotics are commonly used in clinical medicine.

Because quinolones have good pharmacokinetic properties, they are commonly used antibiotics in the treatment of CPPs. Some scholars have proposed that patients with chronic pelvic pain syndrome CPPS can be treated with experimental antibiotics for six weeks first.

If it is effective, it is recommended to use antibiotics for another six weeks, especially for patients with CPPS who have detected chlamydia or mycoplasma, corresponding drugs should be selected for treatment. However, patients with CPPS can be treated with antibiotics for four weeks. If not, the symptoms may not be related to the infection of the prostate.

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