Skip to main content

Advertisement

Approche pharmacocinétique du traitement antibiotique des infections génitales chroniques masculines

Resume

Le traitement antibiotique des infections génitales chroniques masculines n'est pas satisfaisant car les guérisons sont obtenues moins d'une fois sur deux et les récidives sont fréquentes. La bonne connaissance des propriétés pharmacocinétiques des molécules activesin vitro sur les bactéries responsables de ce type d'infection permet de sélectionner pour le traitement de ces infections des antibiotiques diffusanta priori dans les voies génitales. Cependant les résultats des études faites chez l'animal sont difficilement exploitables. Le diagnostic d'une infection génitale chronique est difficile. La spermoculture ne permet pas toujours d'isoler une bactérie que l'on puisse mettre en cause et elle peut être négative même en cas d'infection bactérienne vraie. Le traitement sera si possible adapté, mais il sera souvent empirique. Les antibiotiques montrant une bonne efficacité (éradication du germe, disparition des symptômes) sont en nombre limité: cyclines, triméthoprime-sulfaméthoxazole, macrolides et fluoroquinolones. Ils devront être prescrits pour une période d'au moins 6 semaines.

Abstract

Antibiotherapy of chronic bacterial genital infection is not satisfactory as patients are cured in less than one case upon two and relapse is frequent. A good knowledge of pharmacokinetics of antibiotics with good activity in vitro against responsible bacteria is compulsory. In man, local diffusion of antibiotics is limited to prostatic tissue or secretions in noninfected individuals. No data are available in patients with chronic infection which are known to modify secretion parameters and could alter antibiotics diffusion. For pharmacological studies animal models are of limited help. Dog prostate is very different from men's one and secretion are very acidic but it is a very convenient model for obtaining prostatic secretions. Rat prostate is easily removed and may be infected experimentally. However, it is difficult to extrapolate the obtained results to human. Thus, antibiotic diffusion in male genital tract remains largely unknown. Ehtical reasons render more thorough investigations impossible. Antibiotherapy of chronic genital infection has to be adapted to isolated bacteria and must use drugs with a good local diffusion. However, this is difficult as cultures of semen and/or prostatic secretions do not always permit isolation of bacteria. Thus, the treatment is often empirical. Antibiotics with good efficacy (elimination of bacteria, regression of symptoms) are of limited number: cyclines, trimethoprim-sulfamethoxazole, macrolides and fluoroquinolones. They have to be administered for at least 6 weeks because of the chronic infectious process.

Bibliographie

  1. 1.

    BARZA M., CUCHURAL G.: The penetration of antibiotics into the prostate in chronic bacterial prostatitis. Eur. J. Clin. Microbiol. 1984, 3: 503–505.

  2. 2.

    BARZA M.: Anatomical barriers for antimicrobial agents. Eur. J. Clin. Mircobiol. Infect. Dis. 1993, suppl. 1: S31-S35.

  3. 3.

    BERMAN B., WEDREN H., HOLM S.E.:Staphylococcus saprophyticus in males with symptoms of chronic prostatitis. Urology 1984, 34: 241–255.

  4. 4.

    DAN M., GOLOMB J., GOREA A., LINDNER A., BERGER S.A.: Penetration of norfloxacin into prostatic tissue following single-dose oral administration. Chemotherapy 1987, 33: 240–242.

  5. 5.

    Dictionnaire Vidal, Ed. du Vidal, Paris, 1995.

  6. 6.

    EYKYN S., BULTITUDE M.I., MAYO M.E., LLOYD-DAVIES R.W.: Prostatic calculi as a source of recurrent bacteriuria in the male. Br. J. Urol. 1974, 46: 527–532.

  7. 7.

    FOULDS G., MADSEN P., COX C., SHEPARD R., JOHNSON R.: Concentration of azithromycin in human prostatic tissue. Eur. J. Clin. Microbiol. Infect. Dis. 1991, 10: 868–871.

  8. 8.

    GRISE PH, LEMELAND J.F., HUMBERT G.: Critères de diagnostic des prostatites chroniques. La Lettre de l'Infectiologue 1994, 9: 312–316.

  9. 9.

    HOFSTETTER A., RANGOONWALA R., BOHN G., EICHSTÄDTER H.M.: Harnbeimenengungen im Prostataexprimat. Diagnostk. 1977, 10: 78.

  10. 10.

    LABAUNE J.P.: Pharmacocinétique — Principes fondamentaux, Ed. Masson, Paris, 1988: 7–33.

  11. 11.

    GERDING D.N., PETERSON L.R., HUGHES C.E., BAMBERGER D.M.: Extravascular antimicrobial distribution in man. In: Lorian V. ed. Antibiotics in laboratory medicine. Baltimore, William and Wilkins, 1986: 938–94.

  12. 12.

    MADSEN P.O., DRESCHER P., GASSER J.C. Basis for antibacterial treatment of protatitis: experimental and clinical pharmacokinetic studies and models. In: Weidmer W., Madsen P.O., H.G. Schiefer eds. Prostatitis: etiopathology, diagnosis and therapy. Berlin, Springer-Verlag, 1994: 109–22.

  13. 13.

    MEARES E.M.: Prostatitis: observations on activity of trimethoprim-sulfamethoxazole in the prostate. J. Infect. Dis. 1973, 128: 679.

  14. 14.

    MEARES E.M.: Infection stones of the prostate gland. Laboratory diagnosis and clinical management. Urology 1974, 4: 560–566.

  15. 15.

    MEARES E.M.: Prostatitis: review of pharmacokinetics and therapy. Rev. Infect. Dis 1982, 4: 475–483.

  16. 16.

    MOBLEY D.F.: Erythromycin plus sodium bicarbonate in chronic bacterial prostatitis. Urology 1974, 3: 60–62.

  17. 17.

    NABER K.G., SÖRGEL F., KEES F., SCHUMACHER H., METZ R., GROBECKER H.: In vitro activity of lferoxacin against isolates causing complicated urinary tract infections and concentrations in seminal and prostatic fluid and in prostatic adenoma tissue. J. Antimicrob. Chemother. 1988, 22 (suppl. D): 199.

  18. 18.

    NABER K.G.: Use of quinolones in urinary tract infections and prostatitis. Rev. Infect. Dis. 1989, 11: 1321.

  19. 19.

    NABER K.G., KINSIG M., SÖRGEL F., WEIGEL D.: Penetration of ofloxacin into prostatic fluid, ejaculate and seminal fluid. Infection, 1993, 21: 28–30.

  20. 20.

    NABER K.G., SÖRGEL F., KINSIG M., WEIGEL D.M.: Penetration of ciprofloxacin into prostatic fluid, ejaculate and seminal fluid in volunteers after an oral dose of 750 mg. J. Urol. 1993, 150: 1718–1721.

  21. 21.

    NEUMAN M.: Vade-mecum des antibiotiques et agents chimiothérapiques anti-infectieux, Ed. Maloine, Paris, 1990.

  22. 22.

    NICKEL J.C., COSTERTON J.W.: Bacterial localization in antibiotic-refractory chronic bacterial prostatitis. Prostate 1993, 23: 107.

  23. 23.

    NICKEL J.C., DOWNEY J., CLARK J., CERI H., OLSON M.: Antibiotic pharmacokinetics in the inflammed prostate. J. Urol. 1995, 153: 527–529.

  24. 24.

    NIELSEN M.L., HANSEN I.: Trimethoprim in human prostatic tissue and prostatic fluid. Scand. J. Urol. Nephrol. 1972, 6: 244.

  25. 25.

    ORLAND S.M., HANNO P.M., WEIN A.J.: Prostatitis, prostatosis and prostatodynia. Urology 1985, 25: 439–459.

  26. 26.

    PAULSON D.F., WHITE R.D.: Trimethoprim-sulfamethoxazole and minocycline-hydrochloride in the treatment of culture-proved bacterial prostatitis. J. Urol. 1978, 102: 184–185.

  27. 27.

    SCHAEFFER A.J., DARRAS F.S.: The efficacy of norfloxacin in the treatment of chronic bacterial prostatitis refractory to trimethoprim-sulfamethoxazole and/or carbenicillin. J. Urol. 1992, 144: 690.

  28. 28.

    STAMEY T.A., MEARES E.M., WINNINGHAM D.G.: Chronic prostatitis and the diffusion of drugs into prostatic fluid. J. Urol. 1970, 103: 187–194.

  29. 29.

    WEIDNER W., SCHIEFER H.G., BRÄHLER E.: Refractory chronic bacterial prostatitis: a re-evaluation of ciprofoxacin treatment after a median follow up of 30 months. J. Urol. 1991, 146: 350.

  30. 30.

    WHELTON A., STOUT R.L.: An overview of antibiotic tissue penetration. In: Ristuccia A.M., Cuhna B.A. eds. Antimicrobial Therapy. New York: Raven Press, 1984, 365–378.

Download references

Author information

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Lozniewski, A., Drouinot, V., Weber, M. et al. Approche pharmacocinétique du traitement antibiotique des infections génitales chroniques masculines. Androl. 6, 228 (1996). https://doi.org/10.1007/BF03034453

Download citation

Mots clés

  • infection génitale chronique
  • antibiotique
  • pharmacocinétique
  • prostate
  • traitement

Key-words

  • chronic genital infection
  • antibiotics
  • pharmacokinetics
  • prostate
  • treatment