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Levofloxacin and Its Effective Use in the Management of Bacterial Prostatitis

Kurt G. Naber, MD, PhD
Technical University of Munich, Munich, Germany

Prostatitis is well-recognised around the world as having a significant impact on men of all ages. It imposes a huge economic and medical burden upon healthcare systems, affecting 10-14% of all men. In acute bacterial prostatitis Gram-negative bacteria remain the principal pathogens responsible for this usually severe infection, with treatment requiring administration of a broad spectrum antibiotic for 2-4 weeks. Subsequent identification of the causative pathogen, along with susceptibility tests, allows antimicrobial therapy to be tailored to the individual patient. In contrast to acute prostatitis, the chronic form of the disease is more difficult to diagnose, usually presenting with general symptoms common to other pelvic pathologies. Optimal management of this condition is made more difficult by the fact that only 10% of patients with chronic prostatitis symptoms actually have a bacterial infection. The most likely pathogens responsible for chronic prostatitis are the common uropathogens and the role of Gram-positive bacteria in this situation remains unclear. The best routine method of differentiating between this condition and chronic pelvic pain syndrome is the use of the Meares-Stamey four-glass test or the two-glass test. Fluoroquinolones remain the first choice of therapy for chronic bacterial prostatitis, in particular levofloxacin which is as effective as ciprofloxacin but has added advantages of achieving better prostatic and seminal fluid penetration and can be administered once daily.

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