慢性細菌性前立腺炎に対するrifampicinとST合剤の併用療法および抗生剤局注療法について

Abstract

細菌性慢性前立腺炎70例に, リファンピシン・Trimethoprim (ST)合剤併用例と, ST合剤単独例とに分け, おのおのの有効性を比較検討した.起炎菌は両群ともグラム陽性菌が大多数を占め, グラム陰性菌は少数であった.自覚症状, 前立腺部圧痛, 前立腺液中白血球数を指標にし治療効果を判定すると, 有効率は前者73%, 後者60%, 治癒率は前者40%, 後者21%で, いずれもリファンピシン・ST合剤併用群が良好な成績を示した.起炎菌別の効果は, リファンピシン・ST合剤併用例ではSt. epidermidisとSt. aureusに対し良好で, E. coliにも有効であった.ST合剤単独例では, 有効例の約67%がSt. epidermidisとSt. aureusであった.トブラマイシン, 1%キシロカイン, 10% NaClを用いた前立腺局注療法を7例に施行し, 有効率は57%であった.局注後に前立腺生検を施行し, 電顕的観察を行うと, 腺細胞内に抗生剤の取り込みによると思われる濃い円形構造物を含むライソゾームの発達を認めた

Seventy out-patients suffering from chronic bacterial prostatitis were treated with a combination of trimethoprim plus rifampicin or trimethoprim alone. A combination of 300 mg. rifampicin plus 160 mg. trimethoprim (rifaprim) was used. Forty-four patients were administered rifaprim at doses of 920 mg. (twice a day) for two months. Twenty-six patients were administered trimethoprim at doses of 320 mg. (twice a day) for two months. Cultures of the expressed prostatic secretions (EPS) yielded gram-positive bacteria in 61 patients and gram-negative bacteria in 9. In rifaprim group, clinical responses were excellent in 9 cases, moderate in 23 cases and poor in 12 cases. The efficacy rate was 73%. In trimethoprim group, excellent in 1 case, moderate in 14 cases and poor in 11 cases. The efficacy rate was 60%. Seven patients of chronic bacterial prostatitis were treated by local injection of tobramycin into the prostate. The antibiotic level in the prostatic fluid twenty-four hours after injection was very high. The pain and discomfort experienced by the patients during injection into the prostate were minimal. Local necrosis was not found after histologic or electron microscopic studies of biopsied prostatic specimen after the injection. Results show that this simple method should be valuable in the treatment of the refractory group of chronic bacterial prostatitis.