The chronic prostatitis syndrome is a multifactorial disease of mainly unknown etiology. Quite different therapeutic options are therefore recommended. According to the new NIH classification only in acute and chronic bacterial prostatitis pathogens can be cultured. A long-term antimicrobial therapy, mainly with fluoroquinolones, is therefore recommended. Most of the patients, however, suffer from a chronic pelvic pain syndrome (CPPS) which can be subdivided into an inflammatory and a non-inflammatory CPPS. Whether the inflammatory CPPS is an infectious disease, remains uncertain. An antibiotic therapy therefore is not the first choice. Several patients, however, have been improved by such a therapy, especially in combination with alpha-receptor blockers. In case of proven or suspected functional obstruction of the bladder neck long-term treatment with relatively high dosages of alpha-receptor blockers is recommended. In case of failure other treatment modalities, including psychosomatics, may be applied, of which usually only results of sporadic reports but not of controlled studies are available. It is important, however, to keep the patient fully informed about the diagnostic and therapeutic problems not to interfere with a trustful therapist-patient relationship.

Adrenergic alpha-Antagonists↗

PubMed2001

In vitro activity of linezolid against Gram-positive uropathogens of hospitalized patients with complicated urinary tract infections.

The antimicrobial activity of linezolid, a recently developed antibiotic agent active against Gram-positive bacteria, was tested against pathogens from three different collections. (1) Uropathogens from hospitalized urological patients (1990/1991) with complicated and/or hospital-acquired UTIs; Urologic Clinic, Hospital St. Elisabeth, Straubing. (2) Uropathogens from a multi-centre study (1995/1996) comprising 37 urological centres throughout Germany. (3) MRSA isolates of patients and staff (1999/2000) within the Hospital St. Elisabeth, Straubing. Genotyping of the latter isolates was performed by pulsed-field-electrophoresis. The minimal inhibitory concentrations (MIC) of linezolid determined by an agar (Isosensitest) dilution method using a multipoint inoculator and an inoculum of 10(4) cfu per point ranged for methicillin susceptible Staphylococcus aureus (MSSA) (n=27) between 2 and 4 mg/l, for methicillin resistant S. aureus (MRSA) (n=35) between 1 and 2 mg/l, for methicillin susceptible coagulase-negative staphylococci (CNS) (MSSE) (n=67) between 0.5 and 4 mg/l, for methicillin resistant CNS (MRSE) (n=19) between 0.25 and 2 mg/l, for Enterococcus. faecalis (n=184) between 0.5 and 4 mg/l, for E. faecium (n=3) 2 mg/l and for Streptococcus spp. (n=4) between 0.25 and 1 mg/l, indicating that all strains were susceptible. According to the in vitro activity, linezolid may be considered a promising antibacterial agent for the treatment of complicated UTI caused by Gram-positive uropathogens. Thus, linezolid should be evaluated in a clinical study.

Acetamides↗

PubMed2001

Uncomplicated urinary tract infections in women.

Uncomplicated urinary tract infections, such as acute uncomplicated cystitis and pyelonephritis, are common infections in otherwise healthy women. Although severe complications are rare, the high prevalence of these infections contributes to significant costs to health care systems. The present review addresses recent publications that concern the epidemiology, pathogenesis, aetiology, diagnosis, treatment and prevention of uncomplicated urinary tract infections and recurrent urinary tract infections in women.

Cystitis↗

PubMed2000

Hospital-acquired urinary tract infections.

Hospital-acquired urinary tract infections have a great impact on clinical medicine. They are almost exclusively complicated urinary tract infections. Clinical diagnosis in some patients. (e.g., sedated patients, paediatric or geriatric patients) might be delayed for the lack of symptoms. About 80% of urinary tract infections are catheter-associated. However, certain diseases favour urinary tract infections: diabetes mellitus or cystic renal diseases, amongst others. Each specialist field (e.g., geriatrics, gynaecology, paediatrics) encounters its own problems concerning diagnosis and treatment of urinary tract infections. Hospital-acquired urinary tract infections can merge into severe infections such as urosepsis and septic shock. The microbiological spectrum encompasses multi-resistant bacteria, thus microbiological sampling prior to therapy is mandatory. Additionally the complicating factors must be diagnosed and treated adequately. The best prophylaxis is to minimize the duration of the urinary catheter and to employ general hygienic procedures.

Cross Infection↗