Prof Schaeffer on Antibiotics and Bacteria

[webslave]

Andrologia. 2003 Oct;35(5):252-7.

Epidemiology and demographics of prostatitis.

Schaeffer AJ. (Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.)

.... Although men with CP routinely receive anti-inflammatory and antimicrobial therapy, recent studies suggest that leucocyte and bacterial counts do not correlate with severity of symptoms. These findings suggest that factors other than leucocytes and bacteria contribute to the symptoms associated with CPPS. ....

[james-d]

OK - but does the study say anything about symptomatic relief with antimicrobial therapy in light of of this?

I really want to understand why quinolones work so well for my symptoms (I have read the stuff on the antiinflamatory effects of antibiotics on cp.com - but it doesn't seem to ring true given the extent of relief they provide).

The reason for my curiousity is this - if it is some other action of the quinolones (not the anti-microbial effect) - maybe if we (ok - not we - but a nerd in a lab coat somewhere) isolate that chemical - a new drug that just performs that function can be created without the other properties of quinolones antibiotics.

I would try a new drug like that in a minute.

[webslave]

My understanding is that a group of quinolones that do not have an antimicrobial effect was under study for treating Crohns Disease several years ago. I have not heard any updates.

[james-d]

Thats interesting - I will try to dig and see if I can find anything on that.
Anyone else know anything about that?

[TK]

James,

I believe you are well aware of these considerations. But this is important information for others, and especially for newcomers.

The idea of using antibiotics for symptomatic relief is something that we must all be wary of. This has harmed many people. It has sidetracked many, and kept them from recognizing the far more likely paths to a real cure.

For many of us who have this condition, that first dose of antibiotics (which of course act as anti-inflammatories) was the first relief that we experience and there is an understandable tendancy to want to hold on to that security.

Many of us also start from various states of panic: As our early symptoms stretch out over months, we read the mainstream information about the "dismal:" prospects for those who have a chronic condition. So that first hit of antibiotics seems llike a revelation. And we tend to pin our hopes on this false sunrise,* blocking out other information and treatments that address the deeper roots of the condition

We tend to overlook the various signals from our own body that are telling us about the real nature of the condition. (For example, why do I feel better after activities that gently stretch upper leg / thigh muscles?) We resist the weight of scientific and clinical evidence that tells us that we must look elsewhere for a real cure. (Treatment for Pelvic Muscle Spasm together with anti-inflammatory supplements are far more likely to help most of us)

So do not fall into the trap of relying on antibiotics for symptomatic relief. This should be a last resort for conditions that are a) terribly debilitating and b) Do not respond to other therapies that have less potential for damage.

Anti-inflammatory treatment is valuable and, as stated, some antibiotics are effective in this area. But what you really need is an effective anti-inflammatory regime that can be used safely over longer periods of time .

Once you get past the desparate fantasy that some kind of powerful pharmaceutical "knockout punch" is going to cure you in 2 weeks or even 2 months, you will learn about the variety of anti-inflammatory drugs / supplements / dietary strategies that have worked for many. This forum and the associated website contain a wealth of information about this.

Re previous posts about new Quinolones, it would be swell if Drug Companies came up with non-antibiotic variations that helped some people with Crohns and other debilitating conditions. But the real question is, can they develop a purely anti-inflammatory quinolone that does not have the dangerous side effects and the potential for damage over time. That would be a flying pig indeed!

More Details:
Antibiotics as anti-inflammatories https://ucpps.men/antibiotics-are-anti-inflammatory-agents

To be added - Links that clearly elucidate:
a) Dangerous Side effects of antibiotics
b) The problem of tolerance / resistant strains


--------------------------------------------------------
*Bear in Mind, I am not talking about the non-chronic condition--roughly speaking, the first 6-8 months of symptoms. Whether or not it is adviseable, and even where there is no indication of bacteria, many physicians will probably continue to treat initial symptoms with antibiotics. A good proportion of these cases will resolve on their own, but the (anti-inflammatory) antibiotics probably do speed this a bit. On the other hand, any rational anti-inflammatory treatment would probably be helpful.

POST EDITED: Thanks to Webslave and dancing emoticons for correcting terminology

[alprost]

The idea of using antibiotics for symptomatic relief is something that we must all be wary of. This has harmed many people. It has sidetracked many, and kept them from recognizing the far more likely paths to a real cure.

For many of us who have this condition, that first dose of antibiotics (which of course act as anti-inflammatories)

TK, I see your point, but I think we need to be cautious about even implying that ABX may provide symptomatic releif in chronic prostatitis / chronic pelvic pain syndrome due to their anti-inflammatory effects. Rather than discourage their use, I think this may actually have the opposite effect in men with CPPS, many of whom are so desperate they will try anything. For example:

PATIENT: Would it be possible to have try a couple of different types of ABX for my condition?

DOCTOR: But we have already established that you do not have an infection - why do you want to take ABX?

PATIENT: It's just that I've read that they can act as anti-inflammatories and may provide symptomatic releif in CPPS

One of the reasons I respect this website and everyone associated with it is the fact that everything is informed by scientific research. For example, I admired Mark's recent changes to the information on Elmiron as a result of the clinical trial which showed it to be no more effective than placebo. I feel a similar situation exists with this issue.

I feel appropriate adivce would be something along the lines of:

Recent high quality clinical trials have shown ABX to be no more effective than placebo in the treatment of CPPS. Therefore, unless you are one of the 6-8% who have an infection, there is no need to take ABX for CPPS, which is primarily a neuromuscular dysfunction. If you have CPPS, you need to be examined for other possible causes, and should not take ABX because (1) They are not effective in the treatment of CPPS; and (2) Like all medications, they can have unwanted side effects.

[james-d]

I must respectfully disagree.

I believe that there must be various causes for this problem - hence the inability for medical science to have a consistent cure.

It seems that some patients respond well to antibiotics right away (first 6 - 8 weeks) and are "cured" - even though they have no detectible infection.

Then there are the chronic cases (all of us!) - and the myriad of things that work for us is so diverse it is mind boglleing.

I am following the protocol posted here with a little deviation - plus I have had direct prostatic injections (see post under success stories) and I am using very low dose long term quinolones. The quality of my life at the moment is greatly improved - 99% better. It may just be a temporary improvement - only time will tell.

But this improvement in my case makes me question if the whole neuromuscular thing is the cause of my case (I do not claim to know the cause - it could be space aliens for all I know).

I believe that for many men - the neuromuscular thing might be the cause - and that physical therapy may cure them. I WILL TRY IT MYSELF IF I RELAPSE!

It seems to me though that the evidence is all over the board - and can be read to support various arguments - I am not supporting any of them - I am just trying to get better - and I believe that it is working for me.

I do not advocate my protocol to others - obviously long term quinolone use is a bad thing - but so was a disability so awful that I could not work or be a father to my son. So - my solution is not ideal even for me - but it does give me my life back.

[alprost]

I must respectfully disagree.

I'm not suggesting for one moment that YOU shouldn't take ABX if they help YOU so much. But the fact that they DO help you so much suggests, to me at least, that you MAY be one of the 6-8%! (Although, you may be one of those few geneticaly pre-disposed individuals in which they do have anti-inflammatory actions).

This does not change the fact that ABX are not reccommended for patients who have had a definitive diagnosis of abacterial prostatitis or CPPS.

The key thing which is missing here is, as usuall, an accurate medical diagnosis. You need to see a Urologist who can tell you whether you have CBP or chronic prostatitis / chronic pelvic pain syndrome - This is the only way to know which you have, AND why ABX are helping you so much, AND why your condition relapses when you stop taking them. Untill you know this, you won't know how to move forward or which treatments are appropriate to you.

None of us can tell you this on-line.

(PS - I'm really glad that you ARE feeling so much better, That's great news!)

[webslave]

The quality of my life at the moment is greatly improved - 99% better.

James, your prostate is full of steroids and anesthetic; it would be best to wait until your body returns to its normal state before debating the topic.

[webslave]

Recent high quality clinical trials have shown ABX to be no more effective than placebo in the treatment of CPPS.

But the study did also find that men on antibiotics had a short term improvement compared to men taking placebo. The improvement did not last until the end of the study. This is exactly what happens in real life too: men frequently report an initial improvment on abx, followed by deterioration.

How is this explained biochemically? My guess is that the abx are altering the levels of ROS or cytokines in such a way that the patient experiences initial improvement. However, the mast cells in the area keep on degranulating unaffected, and eventually other pro-inflammatory products predominate, overwhelming the abx-effect.

[james-d]

Webslave - you bring up an interesting point.

I am having some difficulty finding written documentation on how long the "injected" cocktail of ABX/steroids/antifungals/and lidocaine remain in the prostate.

The uro doing the procedure says they are gone within a day or so but has no opinion on how long the effect can last.

Do you beleive that they remain in the prostate longer then that?

Thanks for any info you can provide.

[webslave]

The prostate is poorly perfused with blood. Something injected into the tubules, acini, stroma and peripheral zones would take longer than a day to clear. By then the cocktail of chemicals would have had their effect well and truly. The gland would be affected for quite a long time thereafter (weeks).

[TK]

we need to be cautious about even implying that ABX may provide symptomatic relief in chronic prostatitis / chronic pelvic pain syndrome due to their anti-inflammatory effects.

You raise very important points, Alprost. I agree wholeheartedly that:

-- we must discourage the use of antibiotics where infection is not clearly indicated.

-- Once the non-bacterial case has reached the the CHRONIC condition -- antibiotics are far less likely to provide the degree of symptomatic relief that people sometimes experience in an earlier phase

-- Whatever symptomatic relief people experience in response to antibiotics at ANY phase, we must explain clearly WHY this approach is a dead end. We must explain it both in terms of the science and we must back this up with the experience of MANY MANY men who have travelled this route to no avail.

Alprost's caution raises a difficult issue of terminology that affects many areas of discussion at this forum. (Please bear with me. I think clarifying this may help for purposes of a number of important topics)

For general purposes, we might say that the CHRONIC state (The "C" in CPPS) is arbitrarily a matter of time. 6 Months? 8 Months? Maybe someone more knowledgeable than myself can elucidate a handful of criteria that tells someone, "OK, you're Chronic now".

But as a practical matter, people arrive at this forum -- some A) some in the first three months of their experiences; B) some at the indeterminate 4-12 month mark; C) Some clearly chronic by reasonable "broad brush" standards.

In terms of prior experience with Antibiotics and understanding of that experience:

To varying degrees, the folks in category C have "been there". If they are not already aware of the science, the more rational people will "get it" as soon as the anti-inflammatory effect (and it's limits) are explained.

The guys in category B who are still desperate for the "Magic Bullet"*. They need the most thorough explaination to help them avoid the dead-end and the genuine dangers of continuing antibiotic therapy.

Category A: these guys need the understanding that their condition is not yet chronic and that, in many cases, it will clear up by itself. Anti-inflammatory drugs / supplements /dietary strategy together with gentle stretches, awareness of pelvic floor may help them get better sooner and avoid problems down the line. And if there has been some symptomatic relief in response to antibiotics, they need to understand the anti-inflammatory effect so that they will not fall into the trap of equating response to antibiotics with evidence of bacterial infection. And should they progress to B or C, they need to know why they should not continue with antibiotics.

Yes, we do risk fueling misunderstandings by explaining the anti-inflammatory effect and symptomatic relief that some experience in stages A and B. This risk exists no matter how thoroughly we address the fallacies and dangers of continuing use of antibiotics

But what's the alternative? If we do not explain this, then many more people will continue to seek antibiotics based on misunderstandings about the symptomatic relief that they may have experienced at Stage A or B. If we do not explain the anti-inflammatory effect, people will continue to seek the antibiotics for both symptomatic relief and because they equate response to antibiotics with evidence of bacterial causality.

I think the comprehensive explanation is the better answer.

PATIENT: Would it be possible to have try a couple of different types of ABX for my condition?

DOCTOR: But we have already established that you do not have an infection - why do you want to take ABX?

PATIENT: It's just that I've read that they can act as anti-inflammatories and may provide symptomatic releif in CPPS

Let's add this:

DOCTOR: Yes, Antibiotics do function as anti-inflammatories. but there are other approaches to inflammation that are both much safer and genuinely more effective over the medium and long term! We now have a successful approach to fighting this condition for many men: pelvic floor therapy together with a sound anti-inflammatory strategy. So we will not resort to dangerous, desperate, "hit and miss" measures that harmed people in the past. More comprehensive information is available.

* See Alprost's excellent post at:
viewtopic.php?p=5283#5283

[alprost]

What can I say - Great post!

Category A: these guys need the understanding that their condition is not yet chronic and that, in many cases, it will clear up by itself. Anti-inflammatory drugs / supplements /dietary strategy together with gentle stretches, awareness of pelvic floor may help them get better sooner and avoid problems down the line. And if there has been some symptomatic relief in response to antibiotics, they need to understand the anti-inflammatory effect so that they will not fall into the trap of equating response to antibiotics with evidence of bacterial infection. And should they progress to B or C, they need to know why they should not continue with antibiotics.

I think there does need to be an element of caution with advice re. ABX in Group A, bearing in mind a small minority of men (i.e. 6-8%) in this category may have an infection, so we can't give out advice on whether or not to take ABX unill they have a definitive diagnosis from their Uro of chronic prostatitis / chronic pelvic pain syndrome and not prostatitis.

I agree with everything you say re. the other groups - excellent analysis!