It is very important to use antibiotics for the treatment of hematospermia due to acute prostatitis or acute vesiculitis, in addition to general treatment, instead of bleeding treatment. However, as the prostate surface is coated with a layer of lipid substances, many kinds of antibiotics are difficult to penetrate through this membrane and into the gland to achieve therapeutic effects. It is necessary to follow the following principles for the treatment:
(1) Select right drug according to the result of antimicrobial susceptibility test.
(2) Select antibacterial drugs with high lipid solubility, high permeability, low binding rate with protein in plasma as well as high dissociation degree.
(3) For combination therapy, the dosage should be adequate and the course of treatment should be long. Medication should last for more than 4 weeks.
Commonly used drugs and medication methods:
(1) erythromycin: erythromycin has strong penetrating ability so its infiltration of the prostate epithelium is stronger. In the acidic environment it can be dissolved into non soluble state. It is highly sensitive to staphylococcus aureus and streptococcus, while it is invalid to gram-negative bacilli. So it is often used in combination with kanamycin. Usage: erythromycin 0. 25g,four times a day; kanamycin 0. 5g, twice a day, intramuscular injection, 10 to 14 days for the first course of treatment, when the symptoms are improved, take oral compound SMA-TMP 2 tablets for each time, twice a day, and take 10 to 14 days.
(2) SMZ-TMP: the dosage of this drug is 2 tablets for each time, twice a day, for 4 to 6 weeks, it will improve the efficacy of SMZ-TMP to take oral basic drugs with it together.
(3) Cephalosporin and TMP: these drugs can play the role of anti-inflammatory and antibacterial through the blood into the prostate. Commonly used drugs include Cephradine capsule, take two pills each time (500mg), 4 times a day. In severe cases, take 4 ~ 8g every day in 2 divided doses daily by intravenous injection, but it should be paid attention that patient with a history of cephalosporin is prohibited to use it and patient who are allergic to penicillin should used it with caution. The use of TMP mostly is combined with other drugs, such as with sulfonamides which is compound TMP or SMZ-TMP.
(4) The quinolones: the research of antibacterial drugs has developed rapidly in recent years, and the anti-inflammatory drugs for the treatment of acute prostatitis also increased a lot, quinolones and the dosage: norfloxacin take 0. 2g orally each time, 3 times a day; ofloxacin, take 0.2 g orally each time, twice a day; in severe cases, ofloxacin can be administrated as intravenous infusion, 0,2 g each time and twice a day, and the course of treatment is for 10 ~ 15 days. Adverse events were gastrointestinal symptoms, occasionally ALT level is increased. When the condition improves, it is necessary to take other antibiotic drugs.
(5), penicillin-type drugs: some penicillin-type drugs are effective for the treatment of the specific bacteria in the urinary tract, while their efficacy for non-specific bacterial infections is not satisfied; so they are not the first choice in general conditions.