Indian Journal of Urology
UROSCAN
Year
: 2005  |  Volume : 21  |  Issue : 2  |  Page : 128--129

Alpha blockers or antibiotics in chronic prostatitis/ chronic pelvic pain syndrome - what is the evidence?


J Chandra Singh, Nitin S Kekre 
 Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India

Correspondence Address:
J Chandra Singh
Department of Urology, Christian Medical College,Vellore 632 004, Tamilnadu
India




How to cite this article:
Chandra Singh J, Kekre NS. Alpha blockers or antibiotics in chronic prostatitis/ chronic pelvic pain syndrome - what is the evidence?.Indian J Urol 2005;21:128-129


How to cite this URL:
Chandra Singh J, Kekre NS. Alpha blockers or antibiotics in chronic prostatitis/ chronic pelvic pain syndrome - what is the evidence?. Indian J Urol [serial online] 2005 [cited 2019 Dec 9 ];21:128-129
Available from: http://www.indianjurol.com/text.asp?2005/21/2/128/19641


Full Text

Ciprofloxacin or tamsulosin in men with chronic prostatitis/chronic pelvic pain syndrome: a randomized, double-blind trial. Alexander RB, Propert KJ, Schaeffer AJ, Landis JR, Nickel JC, O'Leary MP et al.

 COMMENTS



This is a multicentric prospective randomized, double-blind trial[1] with a 2 x 2 factorial design to compare the efficacy of ciprofloxacin, tamsulosin, both or placebo for a duration of 6 weeks in men with chronic prostatitis /chronic pelvic pain syndrome (CP/CPPS). Primary diagnostic criterion was pain or discomfort in the pelvic region for at least 3 months. Severity of symptoms was assessed by the use of the National Institutes of Health Chronic Prostatitis Symptoms Index (NIH-CPSI). Permuted block randomization schedule was used and 49 subjects were assigned to each group. The sample size was obtained to detect a 4-point treatment difference in the NIH-CPSI total score between baseline and at 6 weeks. Participants were randomly assigned to receive placebo; ciprofloxacin 500 mg twice daily alone; tamsulosin 0.4 mg alone or a combination of both. NIH-CPSI score was used for assessment of response. The primary outcome was the change in the NIH-CPSI total score from baseline to 6 weeks. All the recruited subjects were accounted for. Though there was a modest improvement of approximately 3 to 6 points in all four groups, no significant difference in the primary outcome was seen for ciprofloxacin versus no ciprofloxacin (P=0.15) or tamsulosin versus no tamsulosin (P>0.2). At 12 weeks, no further significant changes were seen. Hence the authors conclude that use of ciprofloxacin or tamsulosin as empirical therapy for men with long-standing CP/CPPS and at least moderate symptoms was not supported by literature.

Earlier randomized trials to study the efficacy of antimicrobials have not consistently been shown to be useful.[2] Although approximately 90% of cases of chronic prostatitis were believed to be of nonbacterial etiology,[3] patients with prostatic symptoms have generally received empirical antimicrobial therapy. In a recent survey, nearly all urologists who responded reported treating at least 50% of their patients with prostatitis with antibiotics.[4] Traditional first-line treatment of prostatitis has been most effectively achieved with trimethoprim (TMP) or trimethoprim-sulfamethoxazole (TMP-SMX) and, more recently, with a fluoroquinolone, such as norfloxacin, ofloxacin, ciprofloxacin, or levofloxacin.[5]

As symptom complexes of chronic abacterial prostatitis and benign prostatic hyperplasia overlap in most men, investigators hypothesized that drug therapy for benign prostatic hyperplasia (such as finasteride and a-blockers) may help some men with chronic abacterial prostatitis.[6] Randomized trials in which alpha blockers have been shown to be effective had enrolled men who were naοve to alpha blockers.[7] The reason why the results of this trial[1] do not support the findings of earlier trials may be because most of the participants had been treated with various medications before enrolment.[1] a-Blockers might have a role in treating CP/CPPS and they seem to work best in men who are naοve to these agents, have moderate to severe symptoms, and who are willing to stay on therapy for >6 weeks.[8]

References

1Alexander RB, Propert KJ, Schaeffer AJ, Landis JR, Nickel JC, O'Leary MP et al. Ciprofloxacin or tamsulosin in men with chronic prostatitis/chronic pelvic pain syndrome: a randomized, double-blind trial. Ann Intern Med 2004;141:581-9.
2Nickel JC, Downey J, Clark J, Casey RW, Pommerville PJ, Barkin J et al. Levofloxacin for chronic prostatitis/chronic pelvic pain syndrome in men: a randomized placebo-controlled multicenter trial. Urology 2003;62:614-7.
3de la Rosette JJ, Hubregtse MR, Meuleman EJ, Stolk-Engelaar MV, Debruyne FM.Diagnosis and treatment of 409 patients with prostatitis syndromes. Urology 1993;41:301-7.
4McNaughton Collins M, Fowler FJ Jr, Elliott DB, Albertsen PC, Barry MJ. Diagnosing and treating chronic prostatitis: do urologists use the four-glass test? Urology 2000;55:403-7.
5Nickel J, Weidner W. Chronic prostatitis current concepts and antimicrobial therapy. Infect Urol 2000;13:S22-S28.
6McNaughton Collins M, MacDonald R, Wilt TJ. Diagnosis and treatment of chronic abacterial prostatitis: a systematic review. Ann Intern Med 2000;133:367-81.
7Nickel JC, Narayan P, McKay J, Doyle C. Treatment of chronic prostatitis/chronic pelvic pain syndrome with tamsulosin: a randomized double blind trial. J Urol 2004;171:1594-7.
8Nickel JC. The three As of chronic prostatitis therapy: antibiotics, alpha-blockers and anti-inflammatories. What is the evidence? BJU Int 2004;94:1230-3.