Levofloxacin shows some use for newly diagnosed folks

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popburner
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Levofloxacin shows some use for newly diagnosed folks

Post by popburner »

I know most of the direction is pointing to lack of detectable infection, but this paper shows certain antibiotics may still be helpful in newly diagnosed patients. I have been doing a lot of thinking recently about Dr. Dimitrakov's and Dr. Nickel's points about potential triggers, including infectious ones. It may be important to get rid of triggers (whether infectious, structural, muscular, psychological, etc) to allow the other treatments (PT, diet, relaxation, neuromodulation, etc) take effect. This study is open to the idea that the antibiotic may be more of an anti-inflammatory or that it is working on some yet un-culturable infection.
Urol Int. 2008;80(2):157-61. Epub 2008 Mar 19.

Treatment for chronic prostatitis/chronic pelvic pain syndrome: levofloxacin, doxazosin and their combination.
Jeong CW, Lim DJ, Son H, Lee SE, Jeong H.
Department of Urology, Seoul National University Hospital, Seoul, Korea.


INTRODUCTION: We performed a prospective, randomized study to examine the efficacies of levofloxacin and doxazosin alone and as a combination therapy in patients with National Institutes of Health (NIH) category III chronic prostatitis/chronic pelvic pain syndrome. PATIENTS AND METHODS: Men with a NIH diagnosis of category III chronic prostatitis/chronic pelvic pain syndrome and who had experienced pelvic pain for more than 3 months during the last 6 months were enrolled. All patients underwent treatment for 6 weeks. The patients were assessed at baseline and after 2 and 6 weeks by using the NIH Chronic Prostatitis Symptom Index. Eighty-one men (average age 40.1 years) were randomized to either the levofloxacin group (n = 26), the doxazosin group (n = 26), or the combination group (n = 29). RESULTS: The average baseline NIH Chronic Prostatitis Symptom Index total scores were 22.6, 22.4, and 24.1, respectively. At 6 weeks, the total scores were 11.2 (response rate 50.3%), 17.7 (response rate 21.1%), and 13.1 (response rate 45.6%), respectively. The levofloxacin group showed a higher response rate than the doxazosin group, not at 2 weeks but at 6 weeks (p < 0.001). CONCLUSIONS: For a 6-week short-term treatment levofloxacin is more effective than doxazosin for chronic prostatitis/chronic pelvic pain syndrome. In addition, levofloxacin monotherapy was also more effective when compared with the combination therapy.

PMID: 18362485 [PubMed - indexed for MEDLINE]
Age:29 | Onset Age:29 | Symptoms: ORIGINALLY - rectal pain, penis tip pain, perineal spasms, golf ball feeling in perineum, painful ejacualation ONGOING - rectal pain, penis tip hypersensitivity, urethral pain at beginning of urination, ejaculatory pain, burning skin around legs and buttox | Helped By: warm baths, NO catastrophic thinking, Physical Therapy; Stanford/Wise-Anderson Protocol; Mirtazipine (Remeron) for anxiety and sleep, dry needling of TPs (NOT injections), PAIN PSYCHOLOGIST (CBT and Commitment and Acceptance Therapy), diet changes - so far eggs are out doing an elimination diet now :) | Worsened By: ANXIETY, FEAR, STRESS, CATASTROPHIC THINKING,heavy weight lifting , sitting too long
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J Dimitrakov
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Re: Levofloxacin shows some use for newly diagnosed folks

Post by J Dimitrakov »

Thanks for posting this, popburner. While I agree with your general thoughts about trying to identify and eliminate potential triggers, I am having trouble understanding the conclusions of the study.

First off, the number of patients per group (26, 26, 29) is quite small and based on a simple statistical sample size calculation, appears unrealistic for such an impressive response rate based on such a small sample size. For comparison, the 2004 Cipro+tamsulosin study enrolled 49 patients per arm (Cipro alone, tamsulosin alone, combination, placebo, Alexander RB and the CPCRN, Annals of Internal Medicine, 2004).

Second, it's unclear what the average age of the patients is. There might be a BPH component, more prevalent in the older age group, which might explain the impressive results in the doxazosin (alpha blocker) group.

Third, there is not placebo group for comparison.

Fourth, 6 weeks is quite a short period of time to assess efficacy.

I don't have the full-text article but it would be interesting to look at those and other questions.

Best,
JD
Last edited by J Dimitrakov on Sat Jun 07, 2008 12:18 am, edited 1 time in total.
This communication provides general information, and is not a substitute for face-to-face medical care. A doctor-patient relationship should not be assumed by the reader.
Jordan Dimitrakov, M.D., Ph.D.
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webslave
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Re: Levofloxacin shows some use for newly diagnosed folks

Post by webslave »

Small sample size, obscure researcher, minor journal, iffy conclusions ... says it all. I saw this study a while ago and did not post it here for those reasons.
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