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

I just came off of a twenty two day antibiotic treatment for bacterial prostatitis, which involved taking Zithromax, Levaquin and Sulfatrim .
I was supposed to be on these antibiotics for 60 days, but I became very sick due to the side effects and had to stop.
My prostatitis showed signs of improvement, so I would like to try this again.
Are there any antibiotics that I can take for this that are not in the family of the three drugs I mentioned, that are as effective, but will not cause the same kind of violent reaction?
I remember taking amoxicillin as a kid and never having any reactions at all, so I can take antibiotics, but finding some choices other than the ones I mentioned is proving to be difficult.
Any help would be appreciated.

Thanks

Views: 738

Comment by Thomas Rodert on August 16, 2014 at 11:22pm

Hi Gerard,

I think the problem might be the Sulfatrim. I've taken many antibiotics and the only one I have a bad reaction to is Bactrim, which I think is just another brand name for the same antibiotic. After some research I found that a reaction to this drug was quite common, so it might be worthwhile trying the other two you took, but dropping the Sulfatrim. This is just my experience, but worth a try. Good luck!

Comment by John L on August 23, 2014 at 7:03am

Actually everyones reaction to medicines is very individual.  What causes side-effects in one person is fine for another.

I certainly hope they at least did a urine culture which identified the bacteria, and which antibiotics it was sensitive to, and which ones it was resistant to

Comment by John L on August 24, 2014 at 9:56pm

You should also request a Semen culture in addition to the urine culture.  Too many Doctors assume that all they need is a urine culture, but if we are truly dealing with a bacterial prostatitis, the semen will be the gold standard

Comment by s mndl on August 24, 2014 at 10:22pm
Nope ..prostate fluid culture. .eps is the gold standard. .bacteria will not show up in semen..but in eps prostatic fluid culture test..my experience almost 2wice..so ask for eps test..
Comment by John L on August 25, 2014 at 9:26am

Actually that is not correct Supantha.  Bacteria will show up, and it did show up in my semen which matched the same one found it the urine culture.  That is the whole point for a lot of folks who have chronic bacterial prostatitis, it is being seeded by the bacteria in the prostate.  There is NO standard on prostate massages.  It can be more vigorous than others, and not obtain proper results, however, probably the reason to be cautious about prostate massage is it can induce sepsis, which is why if someone has signs of  prostatitis caused by an infection, it is advisable that they should be on an antibiotic.

Your conclusion that semen does does not contain bacteria for chronic bacterial prostatitis is not correct.

Comment by jeffos on August 25, 2014 at 9:38am
I had this discussion with my urologist a while ago, and he said that ideally a stamey test should be done and also a semen test...just for the purpose of an accurate localisation: to check where is the infection: urethra, bladder, prostate or seminal vesicle. unfortunately most of the docs dont do it.
Comment by John L on August 25, 2014 at 9:49am

One more thing regarding semen culture for bacterial prostatitis dx and identification it is all over the literature.

http://www.ncbi.nlm.nih.gov/pubmed/16916775

Another advantage is if you are being treated with antibiotics for bacterial prostatitis, a week before the antibiotics run out, a seaman culture can be done as a control.  It may produce a false negative because of the antibiotic, however, if it is positive, it indicates that the infection is still present, and you either need to continue with the antibiotic, or consider and alternative.  After the course of antibiotics is finished, another semen culture would be performed to confirm no bacteria.  

and though prostate massage and prostatic fluid ext ration is a known standard as you point out, there are real risks with that procedure if the bacteria gets into the blood stream from a vigorous massage

Comment by John L on August 25, 2014 at 10:11am

Hi jeffos, yes that is the classic test.  However, I think another reason it is not frequently done is they believe it is easy enough to do a urine culture to find the bacteria, if it is there.  Problem with that is that the urine culture depending when it is taken may not show anything, when there is something there.  Same with a Semen culture.  Reason I have an issue with a prostate massage is because there is a risk of sepsis from the procedure, and at least for me, when I evaluate something, I weigh risk verses reward, and if there are other methods that can possibly yield the same results without the risks, then I will look at those alternatives.

My personal situations was induced by a prostate biopsy.  Two days after that procedure I had fever, chills, etc. was not feeling week at all.  Instead of doing any culture they just put me on levaquin for a couple of weeks, which after it was finished, it came right back, at which time I requested a culture of both urine and blood.  The urine showed the bacteria was resistant to levaquin, and they put me on Bactrim.  First time 4 weeks on bacterim, 8 days later UTI.  Then 6 weeks bacterim, 7 days later UTI.  This last time I insisted on both a urine and a semen culture.  The urine culture was negative, but the semen culture was positive for the same e-coli that was resistant to the levaquin, but not the bacterim.  I am currently on bacterim again to keep things under control, but want to see the Uro to see how to proceed

good luck to all of us

 

Comment by s mndl on August 25, 2014 at 12:07pm
I totally disagree with u mr.john.there is a reason for that. .seminal fluid and prostatic fluid have difference..I had recurring mdr ecoli uti almost for6 months. .my semen culture also had the same bacteria. .it was recurrent. .my cultures semen and urine turned negative after that..but my symptoms persisted..so I changed 4 urologist. .they all said get lost..I found a andrologist who asked for eps test. .I asked whether I will get a septic shock. .he said..no..and that's the only way of getting prostatic fluid. .first culture yielded enterocccus faecalis. .I was on antibiotics. .second was negative. ..I had the symptoms still. .so I got the third one to show that I was right. .and guess what again it has the same bacteria with same antibiotic sensitivity pattern. .dat day I concluded thia disease can never be cured because of the damn anatomy of the prostate. .bcz of prostate barrier. .all prostatis are bacterial. .after taking antibiotics nothing will show up in cultures. .and one more thing there are 2type of cultures aerobic and anaerobic culture. .ask for that ..and I bet it will be recurrent all ur life...no cure..if bacteria is gone. .we are cured..but bcz of its structure. ..we suffer and..saga continues. ..
Comment by John L on August 25, 2014 at 12:22pm

supantha, I am not disagreeing with you about eps being diagnostic through the prostatic fluid, what I am saying is that if the bacteria could be found in a urine or semen culture it might be enough.  As far a your doctor saying you could not get septic shock from a prostate massage that is not correct.  Especially, if a blood vessel gets broken while the massage is administered.

Your situation is different then mine,  For one thing different bacteria.   I also got mine from a prostate biopsy. Another thing is after I finished my second round of antibiotics it didn't show up in the urine culture, but did in the semen culture.  What I am saying here is I am not sure that we can generalize what works for one will work for someone else.

I know they don't usually test for anaerobic bacteria, because they "assume" 80% is gram negative e-coli, but that is an excellent point, especially if it remains persistent.  I will definitely consider that next time, thanks.

Depending how this goes, I am looking into perhaps injections of antibiotics directly into the prostate.  Definitely it is very much in the experimental stage, but I am putting that on the back burner.

So supantha, how to you control it?  Do you stay on maintenance antibiotics, or something else?

All the best to you

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