Why is the choice of antimicrobial therapy important in chronic bacterial prostatitis (CBP)?

Updated: Jan 15, 2019
  • Author: Samantha D Kraemer, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

The choice of antimicrobial is critical because the prostate has an epithelial lining and a pH gradient that inhibits antimicrobials from entering the prostatic acini. Ideal antibiotics have a higher dissociation constant to allow diffusion of their non-ionized components into the prostate. In addition, if the antibiotic has a basic pH, it can readily reach much higher concentrations in prostatic fluid than in the plasma because of the pH gradient. Agents able to reach sufficient concentrations in prostatic tissue include fluoroquinolones, macrolides, tetracyclines, and trimethoprim. 

The choice of antibiotics for treatment should also be guided by urine bacterial cultures and sensitivities. It is important to use an antibiotic with broad-spectrum coverage because many different bacteria have been isolated in the prostate, although gram-negative Enterobacteriaceae group are the most common.


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