Prostatitis (Prostate Inflammation): Drug Therapy

Therapeutic target

Healing of the inflammation and thus prevention of complications.

Therapy recommendations

  • Acute bacterial prostatitis (ABP; NIH type I):
    • Immediate, high-dose administration of an antibiotic (see below): fluoroquinolones [first-line antibiotics), third-generation cephalosporins, or piperacillin/tazobactam.
      • Atypical pathogens and intracellular germs: tetracyclines and macrolides.
      • Protozoa such as trichomonads: Metronidazole
    • Selection of antibiotic according to the age of the patient (see below).
    • Change drug if necessary after the arrival of the antibiogram; should be given beyond normalization of body temperature and laboratory values (CRP, PCT) for 2 to a maximum of 4 weeks.
    • Defecation complaints (discomfort during defecation): additionally laxatives (laxatives; preferably swelling agents: eg, psyllium husks).
  • Chronic bacterial prostatitis (CBF; NIH type II: fluoroquinolones.
  • Abacterial prostatitis/chronic pelvic pain syndrome (CPPS, “chronic pelvic pain syndrome”) (NIH type III):
    • Alpha blockers (alpha receptor blockers): tamsulosin.
    • Intraprostatic injection therapy (” into the prostate“) of botulinum neurotoxin A (BoNT/A) (significant benefit in terms of NIH-CPSI and micturition symptoms according to International Prostate Symptom Score (IPSS)).
  • See also under “Further therapy“.

Note: Before antibiotic therapy should be ensured that there is actually a bacterial infection. In the literature, bacterial infection is identified for the cause of prostatitis-like symptoms in only 5 to 10% of cases. * Additional notes

  • Post-finasteride syndrome (PFS): symptoms that persisted for at least 3 months after discontinuation of treatment for androgenetic alopecia with 1 mg finasteride.
    • Somatic symptoms
      • Gynecomastia, lethargy, fatigue, muscle atrophy, increased fat storage, loss of libido, erectile dysfunction, and depression; orgasmic disturbances,
    • Cognitive disorders
      • Severe memory loss, slow thinking process
    • Mental disorders
      • Increased anxiety, affect inhibition, emotional lability, sleep disturbances, insomnia, suicidal ideation.

    Possible cause: the decrease in DHT levels could have effects on the expression of 5α-reductase.Therapy: transdermal substitution of dihydrotestosterone; antidepressants if necessary.

  • Red-Hand.Letter:
    • Patients should be aware of the risk of sexual dysfunction (such as erectile dysfunction, ejaculatory dysfunction, decreased libido) and informed that these may persist for more than ten years after discontinuation of therapy.
    • Patients should be informed that mood changes (including depressed mood, depression, suicidal ideation) have been reported in association with finasteride treatment.

In general, further studies must follow to make definitive recommendations on drug therapy for abacterial prostatitis.

Supplements (dietary supplements; vital substances)

Suitable dietary supplements wg prostatitis (prostatitis) should contain the following vital substances:

  • Vitamins (vitamin C* (ascorbic acid), vitamin E* (tocopherols)).
  • Trace elements (zinc* * )
  • Secondary plant compounds (beta-carotene* (provitamin A))

Legend:risk group* therapy* * .

Suitable dietary supplements for natural defense should contain the following vital substances:

Note: The listed vital substances are not a substitute for drug therapy. Food supplements are intended to supplement the general diet in the particular life situation.