“I went to my urologist and he prescribed me 4 weeks of ciprofloxacin. I have taken the full course, yet my prostatitis symptoms have not shown any signs of improvement. The urologist is saying it’s probably non-bacterial prostatitis.”
“My urologist diagnosed me with prostatitis and prescribed me 2 weeks of doxycycline. My symptoms became much better by the 5th day. But they gradually started coming back again. It has now been a month since the doxy course ended, and my symptoms are back to what they were before taking the antibiotic.”
“My urologist prescribed levofloxacin for 4 weeks to treat my prostatitis. After 2 weeks of the antibiotic, my symptoms were completely resolved. I thought my prostatitis was cured! However, a few weeks after finishing the levofloxacin, my symptoms started reappearing. 2 months later, I was back to square one.”
“For my prostatitis, I have had five different antibiotics, some orally and some intravenously. After each course of antibiotics, I would go back to my urologist with little to no improvement, and he would prescribe me a different antibiotic. Today, after all these antibiotics, I am no better than I was when my problem started.”
These are scenarios that many prostatitis sufferers will relate to. I am in touch with close to 100 people who are dealing with prostatitis, and have heard these stories being repeated with many of them, regardless of where they are from. Antibiotics are the primary form of treatment for prostatitis across the world. If you have visited your urologist and been diagnosed with prostatitis, you have almost certainly walked out of the doctor’s office with a prescription of ciprofloxacin, levofloxacin, doxycycline, azithromycin, or some other antibiotic. Yet, in many cases they do not provide a lasting cure.
The question then arises – If antibiotics are the mainstay of prostatitis treatment, why do they provide low cure rates? Why do so many people not find a long and lasting cure to prostatitis with antibiotics? Why do most prostatitis sufferers only see short term symptomatic improvement while on antibiotics, only for symptoms to reappear within a few weeks of finishing the course of the medicine? I will try to address these questions in this post.
1. The poor vascularity of the prostate gland
The prostate gland is an organ that is made up of muscular tissue. Structurally, it has poor vascularity – it does not have a dense network of arteries and blood vessels to carry large quantities of blood to it. This is important because the body’s blood supply is the main delivery medium for many medicines, including antibiotics.
Every antibiotic has a Minimum Inhibitory Concentration (MIC) towards different bacteria, that must reach the site of infection to stop the bacteria from reproducing. If the bacteria cannot reproduce, they will eventually die, and the infection will be eliminated. The problem that arises with prostatitis is that the infection is in a part of the body that has low levels of blood supply. Low blood supply means that lesser amounts of medicine reach the prostate gland.
Thus, the anatomy of the prostate makes it difficult for high enough concentrations, i.e. concentrations greater than the MIC value of the antibiotic towards your particular pathogen, to reach the prostate to kill the infection completely. These sub-lethal concentrations are able to partly disrupt the bacterial infection and that is what gives temporary symptomatic relief. But without completely eliminating the bacterial colony, enough of the bacteria survive the antibiotic attack to start reproducing again, once the course of the drug finishes.
2. Poor penetration of antibiotics through the outer membrane of the prostate
Along with low vascularity, the prostate’s lipid membrane is another feature of the prostate gland that limits the number of antibiotics that can treat a bacterial infection in the prostate.
Imagine your prostate is a glazed doughnut. The glaze on the doughnut is like the lipid membrane, and it works as a safety shield for the prostate, to prevent toxins from the rest of the body from entering the prostate gland. In the case of prostatitis however, this membrane ends up working unfavorably, shielding the bacteria inside by not allowing antibiotics to permeate through it. Many popular and often prescribed antibiotics like amoxicillin are not able to penetrate this membrane and thus are not effective in treating a prostate infection. It is this reason why drugs like the fluoroquinolones are used for prostatitis treatment, despite their toxic side effects. They are one of the few classes of antibiotics that are able to penetrate the prostate’s outer membrane.
3. Evolution of the bacteria to form antibiotic resistance
Antibiotic resistance is an increasing problem globally, Bacteria evolve rapidly to develop resistance to the existing antibiotics that are used against them. The main reason for bacteria to become resistant to a particular antibiotic is a sub-lethal dosage of that drug applied to the bacterial colony. This sub-lethal dosage is able to eradicate only a part of the bacterial colony. The remaining colony evolves to develop resistance to the antibiotic. Once the bacterial strain is resistant to the antibiotic, it will not be impacted by that drug and will continue to infect the host. The anatomical quirks of the prostate ensure that in many cases, only sub-lethal doses of the antibiotic reach the site of infection. This encourages resistance and creates a persistent, chronic infection in the prostate.
4. Prostatitis is a Biofilm infection
Prostatitis is a biofilm infection, and antibiotics have major limitations in being able to treat a biofilm infection. I have talked about this in detail in my previous post. Please go through the post “Biofilms and Chronic Prostatitis” to read more about this.
Antibiotics have these drawbacks when it comes to treating prostate infections, and that is why they provide low cure rates and short-term improvements in many cases. After trying antibiotics for sustained periods of times with no permanent resolution of their problems, many sufferers turn to alternative treatments. I, too, was one of them, and have had courses of azithromycin, doxycycline, ofloxacin, ciprofloxacin and amikacin, with no improvement or lasting impact of any of these on my prostatitis. So, to be able to deal with prostatitis successfully, you need to find a treatment that overcomes the drawbacks of antibiotics vis-a-vis the prostate, and can eliminate the bacterial infection from the root from within the prostate gland.
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