Levaquin in Treatment of Chronic Prostatitis

• Mechanism of Action
• Side Effects
• Resistance to Quinolones
• Therapeutic Use Of Quinolones
• The Major Pitfalls in Treating Chronic Prostatitis

The fourth generation quinolones (best known in the group is Levaquin) offer much improved microbial coverage including both gram positive and gram-negative organisms.

Mechanism of action

Quinolones rapidly inhibit DNA synthesis resulting in rapid bacterial death. Oral administration is just as effective as giving the drug intravenously. Due to their slow metabolism, one 500 mg tablet every 12 hour maintains adequate antimicrobial blood level. When used in combination with amynoglycosides additive effect is not proven and Cipro and Rifampin seems to be antagonistic when used against Staphylococcus aureus.

Though after oral administration the drug rapidly absorbs, effectiveness is reduced by chelating with aluminum or magnesium (antacids) or calcium, iron or zinc (vitamins). The drug is eliminated in most part through the kidneys and lesser part through the liver. Quinolones are readily distributed in body fluids and bacteriostatic levels are achieved in the urine and in the prostatic secretion.

Side effects

In general, Levaquin is well tolerated. Up to 20% of the patients will develop gastrointestinal and central nervous system symptoms. Headaches, dizziness and drowsiness are not uncommon. EKG may show QT abnormality. Patients may report arrhythmias.

Resistance to Quinolones

Unfortunately drug resistance rapidly develops during therapy. If urinary pathogens are the indications for Levaquin therapy, resistant strains could be encountered due to previous administration of the drug to an unrelated condition (pneumonia or a previous STD)

Therapeutic use of Quinolones

Urinary tract infections: In about 89% of patients prompt response is achieved with a ten to 14 day therapy course. Unfortunately recurrence rate is very high due to development of rapid resistance.

In Prostatitis

In the treatment of prostatitis the fourth generation quinolones have gained favor due to their broad-spectrum coverage against both aerobic and anaerobic bacteria, including uropothogens and they exhibit very good coverage against Legionella, Chlamydia and the Mycoplasma group.

Levaquin is an excellent drug to treat prostatitis due to its rapid penetration into the prostate. Unfortunately, recurrences are frequent due in part, to the short courses originally prescribed, or rather, to the rapid development of resistant bacteria. As we pointed it out before, Chlamydia plays a very important role in causing chronic prostatitis. Even if a long course of Levaquin is prescribed as a single drug regimen, the chances are high that resistance develops even before the course is finished and the symptoms return. Repeated courses of Levaquin thus become ineffectual.

The major pitfalls in treating the first episode of prostatitis

1 Underestimating the frequency of Chlamydia infections in prostatitis
2 Incomplete knowledge of the life cycle of Chlamydia
3 A complete lack of appreciation of the fact that this organism not only develops resistance to antibiotics but it has infinite resources to evade detection. Chlamydia is polymorphic both in its antigenic and its pathogenic potentials
4 Finally, Chlamydia will bewilder patients and doctors alike due to the simple fact that acute or chronic prostatitis can develop for no apparent reason from vertically inherited strains of this bacterium