Cipro (Ciprofloxacin) in Chronic & Acute Prostatitis Treatment

• Chemistry and dosage
• Indications for Usage
• Side Effects
• Pitfalls in the Use of Chronic Prostatitis

Chemistry and dosage

Cipro is a second-generation quinolone and prior to the availability of Levaquin, Cipro was the most frequently prescribed antibiotic for the initial symptoms of prostatitis. The drug comes in 250, 500 or 750 mg tablet forms, 5% or 10% oral solution and 200 mg or 400 mg vials for intravenous administration.For adults the usually prescribed dose is 500 mg twice daily for two to four weeks. Indications for Ciprofloxacin.

Urinary Tract Infections

Caused by Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Serratia marcescens, Proteus mirabilis, Providencia rettgeri, Morganella morganii, Citrobacter diversus, Citrobacter freundii, Pseudomonas aeruginosa, methicillin-susceptible Staphylococcus epidermidis, Staphylococcus saprophyticus, or Enterococcus faecalis. Acute Uncomplicated Cystitis in females
Caused by Escherichia coli or Staphylococcus saprophyticus
Chronic Bacterial Prostatitis
Caused by Escherichia coli or Proteus mirabilis
In addition to the above listed indications Cipro has been used in a wide variety of skin, bone, joint, intra-abdominal infections with sensitive bacteria. Before the availability of drugs with fewer side effects Cipro was used for uncomplicated cervical and urethral gonorrhea.

Side effects of therapy

The most frequently reported drug related events from clinical trials were nausea (2.5%), diarrhea (1.6%), liver function tests abnormalities (1.3%), vomiting (1%), and rash (1%).

Experience with Prostatitis

In the great majority of the initial infections ushering in acute or chronic prostatitis, urethral and bladder symptoms are dominating. It is therefore little wonder that the choice for Cipro became popular. Cipro has an excellent spectrum of coverage against uropothogens and quite a few enteric bacteria residing on the perineum respond favorably to Cipro as well. Often, after a short Cipro course, one can see a temporary improvement in urinary symptoms.

Unfortunately, Cipro has negligible coverage against anaerobic bacteria, Chlamydia and the Mycoplasma group. Therefore, it allows these pathogens to establish themselves in the prostate leading to the development of genuine prostate related symptoms. Repeat Cipro courses will predictably fail and precious time is wasted in the management. Since Chlamydia has such an important role in the pathogenesis of Chronic Prostatitis, second-generation quinolones such as Cipro have no role in treating any type of UTIs. If one of the quinolones is chosen it should be a fourth generation drug such as Levaquin. Levaquin has very good coverage against anaerobes as well as against the Chlamydia and Mycoplasma group; it may be used in combination with other antibiotics for optimal efficacy.

One should be mindful, however, not to use single drug regimens in the treatment of the initial phase of prostatitis. Many bacteria, including Chlamydia (with varying degrees of susceptibility depending on phase) will rapidly develop resistance to single drug regimens if not completely eradicated. A second course of the same antibiotic is ineffective when symptoms return. We have seen this happen many times in our practice, that I consider using single drug regimens in the treatment of acute or chronic prostatitis misguided medical practice.