Eficácia Clínica da Antibioterapia na Prostatite Crónica por Microrganismos Resistentes aos Antibióticos de Primeira Linha

Ana Catarina Andrade; Luís Pacheco Figueiredo; Paulo Dinis

doi:10.24915/aup.37.1-2.85

Autores

Ana Catarina Andrade Faculdade de Medicina da Universidade do Porto, Porto, Portugal
Luís Pacheco Figueiredo Serviço de Urologia, Hospital de São João, Porto, Portugal; Escola de Medicina da Universidade do Minho, Braga, Portugal
Paulo Dinis Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Serviço de Urologia, Hospital de São João, Porto, Portugal

DOI:

https://doi.org/10.24915/aup.37.1-2.85

Palavras-chave:

Antibacterianos/uso terapêutico, Farmacorresistência Bacteriana Múltipla, Prostatite crónica/tratamento farmacológico

Resumo

Introdução: Métodos: Resultados: Discussão: Conclusão: A prostatite crónica bacteriana corresponde a 5% - 10% dos casos de prostatite crónica, sendo responsável porum declínio significativo na qualidade de vida destes doentes. A abordagem terapêutica atual da prostatite crónica bacteriana baseia-se em antibioterapia de longa duração com fluoroquinolonas. Contudo, muitos destes casos recidivam com resistência e requerem antibioterapia, por vezes por via parentérica, em regime de internamento. Este trabalho apresenta uma revisão da literatura relativa à eficácia de alguns antibióticos, por via oral, no tratamento da prostatite crónica bacteriana por microrganismos resistentes aos antibióticos de primeira linha.

Métodos: Revisão da literatura, seguindo a metodologia PICO, através da PubMed, utilizando como palavras-chave: “prostatitis”, “nitrofurantoin”, “macrolides”, “fosfomycin”, “amoxicillin”, “cephalosporins”, “tetracycline” e “doxycycline”.

Resultados: Foram incluídos 15 estudos que avaliaram a eficácia clínica (cura clínica) e/ou microbiológica (erradicação bacteriana) em homens com prostatite crónica bacteriana por diversos agentes etiológicos tratados com fosfomicina, amoxicilina, macrólidos ou tetraciclinas. E

Discussão: Em duas séries de casos publicadas, a fosfomicina e a combinação amoxicilina-ácido clavulânico apresentaram eficácia parcial na prostatite crónica bacteriana por Enterobacteriáceas multirresistentes. A combinação fluoroquinolona-macrólido revelou-se também muito eficaz na prostatite por agentes etiológicos tradicionais. A maioria da investigação sobre o papel dos macrólidos e tetraciclinas na prostatite crónica bacteriana está direcionada para agentes atípicos intracelulares, sendo de primeira escolha nesta etiologia.

Conclusão: Dada a necessidade de novas alternativas para o tratamento da prostatite crónica bacteriana resistente, são precisos mais estudos nesta área.

Downloads

Não há dados estatísticos.

Referências

Turner JA, Ciol MA, Von Korff M, Rothman I, Berger RE. Healthcare use and costs of primary and secondary care patients with prostatitis. Urology. 2004; 63:1031-5.

Krieger JN, Lee SW, Jeon J, Cheah PY, Liong ML, Riley DE. Epidemiology of prostatitis. Int J Antimicrob Agents. 2008;31 Suppl 1:S85-90. doi: 10.1016/j.ijantimicag.2007.08.028.

Krieger JN, Thumbikat P. Bacterial prostatitis: bacterial virulence, clinical outcomes, and new directions. Microbiol Spectr. 2016;4. doi: 10.1128/microbiolspec.UTI-0004-2012.

Cai T, Mazzoli S, Meacci F, Boddi V, Mondaini N, Malossini G, et al. Epidemiological features and resistance pattern in uropathogens isolated from chronic bacterial prostatitis. J Microbiol. 2011;49:448-54. doi: 10.1007/s12275-011-0391-z.

Grabe M, Bartoletti R, Bjerklund-Johansen TE, Cai T, Çek M, Köves B, et al. Guidelines on Urological Infections, 2015. European Association of Urology. [acedido em julho de 2017] Disponível em: http://uroweb.org/wp-content/uploads/EAU-Guidelines-Urological-Infections-v2.pdf

Bonkat G, Pickard R, Bartoletti R, Bruyère F, Geerligns S.E,Wagenlehner B, et al. Guidelines on Urological Infections, 2017. European Association of Urology. [acedido em julho de 2017] Disponível em: http://uroweb.org/wp-content/uploads/19-Urological-infections_2017_web.pdf

Perletti G, Marras E, Wagenlehner FM, Magri V. Antimicrobial therapy for chronic bacterial prostatitis. Cochrane Database Syst Rev. 2013;8: CD009071. doi: 10.1002/14651858.CD009071.pub

Stamatiou K, Pierris N. Mounting resistance of uropathogens to antimicrobial agents: A retrospective study in patients with chronic bacterial prostatitis relapse. Investig Clin Urol. 2017;58:271-80. doi: 10.4111/icu.2017.58.4.271.

Bates D, Parkins M, Hellweg R, Gibson K, Bugar JM. Tigecycline treatment of urinary tract infection and prostatitis: case report and literature review. Can J Hosp Pharm. 2012;65:209-15

de La Blanchardiere A, Dargere S, Guerin F, Daurel C, Saint-Lorant G, Verdon R, et al. Non-carbapenem therapy of urinary tract infections caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae. Med Mal Infect. 2015;45:169-72. doi: 10.1016/j.medmal.2015.03.003.

Falagas ME, Kastoris AC, Kapaskelis AM, Karageorgopoulos DE. Fosfomycin for the treatment of multidrug-resistant, including extended-spectrum betalactamase producing, Enterobacteriaceae infections: a systematic review. Lancet Infect Dis. 2010;10:43-50. doi: 10.1016/S1473-3099(09)70325-1.

Perletti G, Skerk V, Magri V, Markotic A, Mazzoli S, Parnham MJ, et al. Macrolides for the treatment of chronic bacterial prostatitis: an effective application of their unique pharmacokinetic and pharmacodynamic profile (Review). Mol Med Rep. 2011;4:1035-44. doi: 10.3892/mmr.2011.575.

Wagenlehner FM, Pilatz A, Bschleipfer T, Diemer T, Linn T, Meinhardt A, et al. Bacterial prostatitis.World J Urol. 2013;31:711-6.

Videcnik Zorman J, Maticic M, Jeverica S, Smrkolj T. Diagnosis and treatment of bacterialprostatitis. ActaDermatovenerolAlpPannonicaAdriat.2015;24:25-9.

Heras-Cañas V, Gutiérrez-Soto B, Almonte-Fernández H, Lara-Oya A, Navarro-Marí JM, Garrido-Frenich A, et al. Antibiotic activity and concentrations in clinical samples from patients with chronic bacterial prostatitis. Actas Urol Esp. 2017;41:631-8.

Gardiner BJ, Mahony AA, Ellis AG, Lawrentschuk N, Bolton DM, Zeglinski PT, et al. Is fosfomycin a potential treatment alternative for multidrug-resistant gram-negative prostatitis? Clin Infect Dis. 2014;58:e101-5. doi: 10.1093/cid/cit704.2020-07-17

Los-Arcos I, Pigrau C, Rodriguez-Pardo D, Fernandez-Hidalgo N, Andreu A, Larrosa N, et al. Long-term fosfomycin-tromethamine oral therapy for difficultto-treat chronic bacterial prostatitis. Antimicrob Agents Chemother. 2015;60: 1854-8. doi: 10.1128/AAC.02611-15.

Grayson ML, Macesic N, Trevillyan J, Ellis AG, Zeglinski PT, Hewitt NH, et al. Fosfomycin for treatment of prostatitis: new tricks for old dogs. Clin Infect Dis. 2015;61:1141-3. doi: 10.1093/cid/civ436.

Wagenlehner FM, Wullt B, Perletti G. Antimicrobials in urogenital infections. Int J Antimicrob Agents. 2011;38 Suppl:3-10. doi: 10.1016/j.ijantimicag. 2011.09.004

Charalabopoulos K, Karachalios G, Baltogiannis D, Charalabopoulos A, Giannakopoulos X, Sofikitis N. Penetration of antimicrobial agents into the prostate. Chemotherapy. 2003;49:269-79.

Beytur A, Yakupogullari Y, Oguz F, Otlu B, Kaysadu H. Oral amoxicillinclavulanic Acid treatment in urinary tract infections caused by extendedspectrum Beta-lactamase-producing organisms. Jundishapur J Microbiol. 2014;8:e13792. doi: 10.5812/jjm.13792.

Foulds G, Madsen P, Cox C, Shepard R, Johnson R. Concentration of azithromycin in humanprostatic tissue.Eur JClinMicrobiol InfectDis. 1991; 10:868-71.

Giannopoulos A, Koratzanis G, Giamarellos-Bourboulis EJ, Panou C, Adamakis I, Giamarellou H. Pharmacokinetics of clarithromycin in the prostate: implications for the treatment of chronic abacterial prostatitis. J Urol. 2001; 165:97-9.

Skerk V, Schonwald S, Krhen I, Strapac Z, Markovinovic L, Kruzic V, et al. Azithromycin in the treatment of chronic prostatitis caused by Chlamydia trachomatis. J Chemother. 2001;13:664-5.

Skerk V, Sternak SL, Roglic S, Skerk V, Lisic M. Diagnosis and treatment of chronic prostatitis caused by Chlamydia trachomatis. J Chemother. 2005;17: 570-1.

Skerk V, Schonwald S, Krhen I, Banaszak A, Begovac J, Strugar J, et al. Comparative analysis of azithromycin and ciprofloxacin in the treatment of chronic prostatitis caused by Chlamydia trachomatis. Int J Antimicrob Agents. 2003;21:457-62.

Skerk V, Krhen I, Lisic M, Begovac J, Cajic V, Zekan S, et al. Azithromycin: 4.5- or 6.0-gram dose in the treatment of patients with chronic prostatitis caused by Chlamydia trachomatis—a randomized study. J Chemother. 2004;16:408-10.

Skerk V, Schonwald S, Krhen I, Markovinovic L, Barsic B, Marekovic I, et al. Comparative analysis of azithromycin and clarithromycin efficacy and tolerability in the treatment of chronic prostatitis caused by Chlamydia trachomatis. J Chemother. 2002;14:384-9.

Magri V, Marras E, Skerk V, Markotic A, Restelli A, Garlaschi MC, et al. Eradication of Chlamydia trachomatis parallels symptom regression in chronic bacterial prostatitis patients treated with a fluoroquinolone-macrolide combination. Andrologia. 2010;42:366-75. doi: 10.1111/j.1439-0272.2009.01033.x.

Jiang SH, Collignon PJ. Treatment of recurrent multiresistant Escherichia coli prostatitis with azithromycin. Med J Aust. 2011;194:208.

Magri V, Trinchieri A, Pozzi G, Restelli A, Garlaschi MC, Torresani E, et al. Efficacy of repeated cycles of combination therapy for the eradication of infecting organisms in chronic bacterial prostatitis. Int J Antimicrob Agents. 2007;29:549-56.

Magri V, Montanari E, Skerk V, Markotic A, Marras E, Restelli A, et al. Fluoroquinolone-macrolide combination therapy for chronic bacterial prostatitis: retrospective analysis of pathogen eradication rates, inflammatory findings and sexual dysfunction. Asian J Androl. 2011;13:819-27.

Skerk V, Marekovic I, Markovinovic L, Begovac J, Skerk V, Barsic N, et al. Comparative randomized pilot study of azithromycin and doxycycline efficacy and tolerability in the treatment of prostate infection caused by Ureaplasma urealyticum. Chemotherapy. 2006;52:9-11.

Seo Y, Lee G. Antimicrobial resistance pattern in Enterococcus faecalis Strains isolated from expressed prostatic secretions of patients with chronic bacterial prostatitis. Korean J Urol. 2013;54:477-81. doi: 10.4111/kju.2013.54.7.477.

Cunha BA, Garabedian-Ruffalo SM. Tetracyclines in urology: current concepts. Urology. 1990;36:548-56.

Ristuccia AM, Cunha BA. Current concepts in antimicrobial therapy of prostatitis. Urology. 1982;20:338-45.

Cunha BA, Gran A, Raza M. Persistent extended-spectrum beta-lactamasepositive Escherichia coli chronic prostatitis successfully treated with a combination of fosfomycin and doxycycline. Int J Antimicrob Agents. 2015;45: 427-9. doi: 10.1016/j.ijantimicag.2014.12.019.

Skerk V, Krhen I, Lisic M, Begovac J, Roglic S, Skerk V, et al. Comparative randomized pilot study of azithromycin and doxycycline efficacy in the treatment of prostate infection caused by Chlamydia trachomatis. Int J Antimicrob Agents. 2004;24:188-91.

Cai T, Mazzoli S, Addonisio P, Boddi V, Geppetti P, Bartoletti R. Clinical and microbiological efficacy of prulifloxacin for the treatment of chronic bacterial prostatitis due to Chlamydia trachomatis infection: results from a prospective, randomized and open-label study. Methods Find Exp Clin Pharmacol. 2010;32:39-45. doi: 10.1358/mf.2010.32.1.1423885.

Smelov V, Perekalina T, Gorelov A, Smelova N, Artemenko N, Norman L. In vitro activity of fluoroquinolones, azithromycin and doxycycline against chlamydia trachomatis cultured from men with chronic lower urinary tract symptoms. Eur Urol. 2004;46:647-50.

Madsen PO,Wolf H, Barquin OP, Rhodes P. The nitrofurantoin concentration in prostatic fluid of humans and dogs. J Urol. 1968;100:54-6.