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
J Chandra Singh
Department of Urology, Christian Medical College,Vellore – 632 004, Tamilnadu
|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 2020 Jan 21 ];21:128-129
Available from: http://www.indianjurol.com/text.asp?2005/21/2/128/19641
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.
This is a multicentric prospective randomized, double-blind trial 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. Although approximately 90% of cases of chronic prostatitis were believed to be of nonbacterial etiology, 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. 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.
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. Randomized trials in which alpha blockers have been shown to be effective had enrolled men who were naοve to alpha blockers. The reason why the results of this trial do not support the findings of earlier trials may be because most of the participants had been treated with various medications before enrolment. 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.
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