Antibiotics & CPPS

[prostateproblem]

Ciprofloxacin or Tamsulosin in Men with Chronic Prostatitis/Chronic
Pelvic Pain Syndrome


A Randomized, Double-Blind Trial
Richard B. Alexander, MD; Kathleen J. Propert, ScD; Anthony J.
Schaeffer, MD; J. Richard Landis, PhD; J. Curtis Nickel, MD; Michael
P. O'Leary, MD; Michel A. Pontari, MD; Mary McNaughton-Collins, MD,
MPH; Daniel A. Shoskes, MD; Craig V. Comiter, MD; Nand S. Datta, MD;
Jackson E. Fowler, Jr, MD; Robert B. Nadler, MD; Scott I. Zeitlin, MD;
Jill S. Knauss, MS; Yanlin Wang, MS; John W. Kusek, PhD; Leroy M.
Nyberg, Jr, MD, PhD; and Mark S. Litwin, MD, MPH, and the Chronic
Prostatitis Collaborative Research Network*

19 October 2004 | Volume 141 Issue 8| Pages 581-589



Background: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)
in men is principally defined by pain in the pelvic region lasting
more than 3 months. No cause of the disease has been established, and
therapies are empirical and mostly untested. Antimicrobial agents and
-adrenergic receptor blockers are frequently used.

Objective: To determine whether 6-week therapy with ciprofloxacin or
tamsulosin is more effective than placebo at improving symptoms in men
with refractory, long-standing CP/CPPS.

Design: Randomized, double-blind trial with a 2 x 2 factorial design
comparing 6 weeks of therapy with ciprofloxacin, tamsulosin, both
drugs, or placebo.

Setting: Urology outpatient clinics at 10 tertiary care medical
centers in North America.

Patients: Patients were identified from referral-based practices of
urologists. One hundred ninety-six men with a National Institutes of
Health Chronic Prostatitis Symptom Index (NIH-CPSI) score of at least
15 and a mean of 6.2 years of symptoms were enrolled. Patients had
received substantial previous treatment.

Measurements: The authors evaluated NIH-CPSI total score and
subscores, patient-reported global response assessment, a generic
measure of quality of life, and adverse events.

Interventions: Ciprofloxacin, 500 mg twice daily; tamsulosin, 0.4 mg
once daily; a combination of the 2 drugs; or placebo.

Results: The NIH-CPSI total score decreased modestly in all treatment
groups. No statistically significant difference in the primary outcome
was seen for ciprofloxacin versus no ciprofloxacin (P = 0.15) or
tamsulosin versus no tamsulosin (P > 0.2). Treatments also did not
differ significantly for any of the secondary outcomes.

Limitations: Treatment lasting longer than 6 weeks was not tested.
Patients who had received less pretreatment may have responded
differently.

Conclusion: Ciprofloxacin and tamsulosin did not substantially reduce
symptoms in men with long-standing CP/CPPS who had at least moderate
symptoms.

*For the members of the Chronic Prostatitis Collaborative Research
Network, see the Appendix.




Editors' Notes



Context


Although the cause of chronic prostatitis/chronic pelvic pain syndrome
(CP/CPPS) is unknown, physicians sometimes try to treat it with
antibiotics or -receptor blockers.


Contribution


In this multicenter, double-blind factorial trial, 196 men with
moderately severe CP/CPPS were randomly assigned to 6 weeks of
treatment with ciprofloxacin, tamsulosin, both drugs, or placebo.
Neither ciprofloxacin nor tamsulosin substantively reduced symptoms.


Implications


Ciprofloxacin and tamsulosin were not effective treatments for
CP/CPPS.


Cautions


Patients had long-standing, refractory CP/CPPS and received trial
treatments for only 6 weeks. Patients with new diagnoses who are given
longer courses of the trial treatments might respond differently.


--The Editors

[alprost]

More evidence that when men (who have had infection ruled out) improve with ABX, it is due to the placebo effect. If you check out the video clips on Dr Wise's website you will see how the electrical activity in a trigger point increases with anxiety, and significantly decreases when the subject practices a relaxation technique
http://www.pelvicpainhelp.com/videos.html
(I'd reccomend checking these clips out if you haven't already done so.)

The placebo effect is largely an anti-anxiety effect, and I'm certain that this is why some men with regular chronic prostatitis / chronic pelvic pain syndrome and no sign of infection improve on ABX - they are reassured they are going to get better, they relax, and their trigger points are less symptomatic. I'm sure there is a passage in AHIP which proposes the same mechanism.

I'm glad this study was done, but I hope it is the last ever study which investigates ABX as a treatment option for chronic prostatitis / chronic pelvic pain syndrome - it really is time to move on...

[latte]

Amen, time to move on. From what we know now the study looks sort of stupid. I guess the uros had to prove it to themselves. When I saw Dr. Anderson he said that the uros still won't listen to him regarding AHIP.