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Acute and chronic prostatitis discussion. Arnon Krongrad, MD, moderator.

I wonder why more effort isn't put into dealing with the biofilms in prostatitis. Studies show that the reason for chronic infections is most often because of bacteria form biofilms and bacteria can be upto 1000x more resistant to attack from the immune system or antibiotics. Bacteria isolated from Chronic Bacterial Prostatitis sufferers seem to be medium to strong producers of biofilms. [1] . There are many compounds under investigation right now known to disperse biofilms, in fact Allicin is able to do this, n-acytel cystein also.  The reason for the chronic cycles of prostatitis where symptoms flare, settle down, flare etc etc... could be because of disruption of dispersal of biofilms allowing free planktonic bacteria form other colonies and thus cause activation of the immune system and further destruction of prostate tisuse. Antibiotics quickly clean up the bacteria that are easiest to kill, which is why there is an initial improvement with antibiotics, but some times patients will relapse with symptoms during treatment or after treatment has ended. Is it not possible that flare ups during treatment of prostatitis does not always indicate treatment failure, but the disruption of biofilms in which causes activation of the immune system against the infection. Thus treatments like allicin (that I think might work well against biofilm infections) could cause flare ups during treatment.  

During treatments of prostatitis with antibiotics I had noticed these cyclic flare ups of symptoms followed by relief, and each time the flare up being less severe.  It is quite possible that using alternative treatments like allicin which is able to both kill bacteria and allow the immune system to attack the bacteria within the biofilm might allow the antibiotics to work better, but used by itself or with antibiotic could cause temporary worsening of infection fromt he disruption and release of billions of bacteria.   The last time I was taking Allicin with antibiotics I had taken  doxycycline, but started to use allicin near the end of treatment. After finishing doxy I started a short course of trimethoprim along with allicin and quercetin. It was mainly during this time I felt cured.  Dealing with the inflammation and normalising the pH of the prostate might help more trimethoprim diffuse into the prostate allowing higher concentrations and to kill any persistent bacteria.  After treatment I noticed weird sensations, like itching, or tingling sensations in the prostate and penis. It's like the sensation when you have a cut and it's healing. Also with resolution of the usual symptoms; fever, frequent urination, pain, burning and so on.
There are many natural compounds that I've researched that are able to prevent biofilms from forming, but have little if no effect on mature biofilms. One of them being Bovine Lactoferrin. Taking lactoferrin (and possibly others, which I don't have time to go into right now) could enhance treatment and prevent treatment failure by stopping bacteria from forming  new biofilms within the prostate. Actually, if you do a pubmed search on biofilms you'll find that in prostatitis lactoferrin levels are elevated. For those that do not understand what lactoferrin does or why it should be used, see this article: . What's more, there is also evidence in-vivo in humans and animals of the effect human and bovine lactoferrin has on immunity and prevention of viral, bacterial and fungal infections.
The problem with using natural compounds from plants is the bioavailability and half-life in humans. In mice they might work, but in humans application of these compounds might not apply. This I am aware of already.  Local injection of NAC, Allicin into the prostate, I don't know if this is feasable approach to dealing with prostatitis when used in combination with antibiotics.

I have been hearing about the development of synthetic compounds that are able to disperse or prevent biofilm formation, disrupt quorum sensing which in turn disrupts communication and the integrity of biofilms, but so far have no heard of these are being used right now in clinical studies or available on the market.
People need to start thinking outside the box and develop new novel ways to deal with bacteria.  I truly believe that bacteria are responsible for the majority of prostatitis in humans. In fact there is a study showing how the toxins from bacteria involved in prostatitis is able to cause pelvic muscle dysfunction. I think that dealing with the muscle issue that comes with prostatitis is not dealing with the core issue at all. Although it might be the only factor in some people, I don't think that is the case for the majority. There will always be symptoms with chronic prostatitis at a low level (sometimes not at all if the bacteria go into a dormant state) and that is why fixes like the stanford protocol is not the complete answer. It just solves one part of the problem.


The pdf I attached is not all in english. It does show the histilogical report and data that might interest you where it shows the cipro + garlic and garlic by itself. Also control. You can see the dramatic effect that using garlic with the antibiotic has.

[1] Mazzoli S. Biofilms in chronic bacterial prostatitis (NIH-II) and in prostatic calcifications.
[2] Biofilms and infections of the upper respiratory tract. (NAC)

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Replies to This Discussion

1) Are there any diseases in which attention to biofilms has led to better management?

2) Are we sure the symptoms of chronic prostatitis are caused by bacteria? viruses? fungi?

3) Is chronic prostatitis like fibromyalgia? Is it neuropathic?

This is a GREAT post, I'm sorry you haven't had more feedback to it.

I am a sufferer of bacterial prostatitis - I had an episode 2½ years ago which I cleared up completely with 6 weeks of cipro. I got reinfected having unprotected sex a year later and cleared that up too. Another year later - same thing, but I took too short courses of antibiotics and now after repeated cycles for a year, it still hasn't been cleared up.


I respond to most antibiotics with one exception -azithromycin. Nothing strange as azithromycin is inactive vs gram-negative uropathogens, and mine is gram-.


However, the interesting fact is that I not only fail to respond to it, I get WORSE from it with intensive flare-ups, wheter combining it with other antibiotics or taken by itself. The azithromycine therapy is done in a pulse matter, with 3 days on and 4 days off - and I would always get the flare ups at about day 3, with decrease in intensity at day 6-7. 


Azithromycine has strongly biofilm inhibiting properties, and I attribute the flare-ups to this. The medicine probably released, as you say, enormous amounts of bacteria from their biofilm protection, causing the flare-ups despite presence of other, active antibiotic. I was able to find another man on a Swedish forum, with bacterial prostatitis who tried several antibiotics with NO, until trying a macrolid that WORSENED his symtoms. Once again, I attribute that to the biofilm-dissolving properties.


For this reason, recent studies conducted by Visnja Skerk, Croatia, suggests that ciprofloxacin treatment should be combined with azithromycine, not only to cover a wider spectrum of bacteria, but also to deal with the biofilms, as most prostate infections occurs in a biofilm state.

Failure of antibiotic treatment in prostatitis does not mean that you don't have an infection, nor that you should focus on pain-killers or other symtom-reliefing medication. The reason to the treatment failure should be pursuited, and I also believe that biofilm formation together with other obstructions, such as calculi or blockage, is what causes relapses and eventually a state of no response to medication.

Your work makes a lot of sense iwillbecured thank you.  You can read my story here.

I created a causes and major factors photo to put things together is i see them if you and others could comment or agree this could hopefully help change opinions in the medical comunity.


We know what where dealing with so we have to make it known to others  I do have other ideas like you both erythromycin can supposedly penetrate biofilm better and could be administered as a suppository with some positive effect. I will see about azithromycine goran but i think we need to agree on curtain things to be heard!

That image was quite good and holds lot of important information. I too can maybe attribute my infections to prolonged intercourses, sometimes without ejaculation. I believe that the last part of it is important, not only to drain the prostate itself, but also to lubricate the urethra with the rather antibacterial seminal fluid.

However, even as we added lot of knowledge about the nature of the disease, we still need more effective treatments. Once we get to the information on biofilm, calculi etc, most of us have several failed antibiotic treatments behind us, and issues with bacterial resistence to the most effective drugs. 

I believe in the direct injection therapy, and I also believe in the intraveneous approach, but none of those have gained popularity, and none is developed and accepted to its full potential. Those few doctors offering direct injections, do not all have access to some powerful antibiotics, like carbapenems and amikacin. I know by experience, that a wide spectrum cocktail is not efficient enough despite the theoretically high concentrations of each drug. In the same way, I also know that using the right antibiotic in an injection, is an extremely effective treatment and probably the best chance for eradication of the pathogens in chronic stages of the infection. 

We also must find a widely accepted, efficient way to clear out calculi from the prostate, as this probably is the cause of reinfection and treatment failure in many cases. 

It is also just as important to never give up - as long as bacteria is the source of symptoms, they can be eradicated and a cure can be achieved, regardless of how hard it may seem. 

Thanks very much Goran i agree with you completely but like i said lets try to make are agreement clear on the causes/major factors for now for all to be seen. Then we could perhaps take this to a medical organisation like the NHS in the uk or Mayo Clinic in the US etc and they could see that people who know their condition agree and thus are more likely to listen.

Then we can do a second diagram Symptoms/Effects which will make them more aware of how severe the condition can be which will hopefully change opinions and create more understanding sympathy resulting in better care

Finally we can put down a Known Cures/Possible Cure Ideas diagram together I think your injection ideas are probably correct and should go on that diagram along with other ideas such as massage and new surgery concepts to help them to help us.

Im in the process of trying to change how this condition is diagnosed and treated for now here in the UK through the complaints procedure process and I will take legal action at a later date if i deam it usefull if no progress is made through the proper channels.



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