Post Date December, 03 2023
Because of the barrier effect of the prostate lipid envelope, most antibacterial drugs are difficult to enter the prostate to achieve effective bacteriostatic concentration, only the alkaline drugs with high liposolubility; Drugs with low binding with plasma protein and high dissociation; Only drugs with good dispersion of prostate lipid membrane can have a better effect. The drugs that meet these conditions include sulfanilamide synergist, compound sulfamethoxazole (containing sulfanilamide synergist), erythromycin, lincomycin, rifampicin, norfloxacin, etc. In addition, drugs such as ofloxacin, minocycline and thalide are more effective. However, some drugs with good effects in theory are not satisfactory in practice. For example, it was reported that only 1/3 of the patients with chronic prostatitis who were treated with sulfanilamide synergist or cotrimoxazole for 12 weeks were cured. The reason is that the local pH changes in patients with prostatitis affect the entry and treatment of drugs. Therefore, whether it is taking medicine, injection, intravenous drip or anal tamponade, the treatment effect is not ideal. It can be seen that the clinical selection of antibiotics must be comprehensively considered, and the drug type should be determined based on the results of bacterial culture and drug sensitivity test of prostate fluid, and adjusted according to the clinical treatment effect.
At present, doctors often adopt the following schemes:
1. For the treatment of rifampicin and sulfa synergist, take 3 to 4 tablets of rifampicin (450 mg to 600 mg) once a day, 2 tablets of sulfa synergist (200 mg) for 15 days, change to 2 tablets of rifampicin (300 mg), 100 mg of sulfa synergist for 105 days, and the standard course of treatment is 4 months. The disadvantage is that rifampicin has hepatotoxic effect and takes a long time; It is difficult for patients to persist. Patients treated with this program should have their liver function checked regularly.
2. Erythromycin 2 tablets (0.25 g) 4 times a day, or tetracycline 2 tablets (0.5 g) 4 times a day for 15 days. Or take azithromycin once a day. The advantage is that it is also effective against mycoplasma infection.
3. Two tablets of ofloxacin (0.2g) three times a day, or two tablets of ciprofloxacin (0.5g) twice a day for 15 days.
4. Two tablets of minocycline (0.1g) twice a day, or one tablet of thalide (0.25g) twice a day for 15 days.
In addition, on the premise of oral quantitative antibiotics, the addition of cortisone or cortisone can strengthen the effect of antibiotics on the permeability of prostate, which can be applied under the guidance of doctors.
(Intern editor: Cai Junyi)
