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METHICILIN RESISTANT STAPH AUREUS PROSTATITIS. Is TURP effective?

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My question regards least intrusive , but possible effective treatment for Methicilin Resistand Staph Aureus bacterial prostatitis

Non traditional symptoms ( nausea, abdomen discomfort, fatigue…. but no enlargement, urinary issues at all) resulted in 6 months of misdiagnosis as GI Issues. Negative urine cultures, semen cultures

Two day thorough work up at Mayo Clinic resulted in diagnosis 3.0 years ago “Methicillin Resistant Staph Aureus Prostatitis” ( I was very sick by now and vigourous prostate massage secreted enough fluid for effective culture.

Sensitivities cultures showed IV antibiotics susceptible plus Bactrim and Minocycline and rifampin.. Of the 10 or so tested.

Over the next 2.5 years , the symptoms would go from very sick to feeling well within a week on Bactrim. Five 4-8 weeks courses were needed and then months of feeling fine.
It seemed that sexual activity without condom would “activate “ infection two weeks later?
IN retrospect should have used condoms and bactrim for 6 months straight ... too late now.

Once again NO BPH ( prostate regular dimensions, no urinary issues at all.) There would be nausea, a little prostate discomfort, projection of pain to front left ( about one inch to left of belly button and two down). Symptoms always worst upon waking anusea and discomfort. As soon as Bactrim taken all symptoms would go away

Tried minocycline once and it had pretty strong hypothyroid consequences. Primarily very irregular heart beat. I never tried to overcome with extra thyroid supplementation .

Recently Bactrim was bacteriostatic at best, didn't improve like past. Doesn't seem to work now to "kill" it off.

I once had to take Zithromax for “travelers diarrhea “ while in Europe and prostate symptoms got better. ( was in conjunction with bactrim)

When I get it I am quite sick and tired, almost like having flu.

Recent careful gray and color Doppler ultrasound study reveals a normal size and configuration prostate for my age. There are multiple calcification, more towards the base. There are no abscesses or masses. There is inflammatory evidence at left mid to apex measuring 12 by 7mm which is the likely location of the infection. It does not appear around the calcification.



Options

Being as I have no BPH , no urinary issues and localized infection along with a 2.5 year interval

I wonder if there would not be other good antibiotics besides bactrim for long term cure of MRSA prostaitis. It is difficult to get a sample... it took being very sick and a very vigorous prostate massage to elicit it last time... after many failed attempts to culture. Infection seen by radiologist on color doppler ultrasound. Or would there be a an immunostimulatory strategy? Other intrusive options like TURP suggested by urologist as a "Hail Mary" has risks of infection and other sides....

Any advice is greatly appreciated !!!!!

Category: Infectious Disease Specialist

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Category: HIV- AIDS Specialist
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Hello,
Thank you for your query at DoctorSpring.com
Your email clearly expresses that you have been through a difficult time with your condition, chronic bacterial prostatitis (due to Methicillin resistant Staph aureaus).
To answer your query of whether immune stimulatory drugs can be used; the answer is no because they drugs are used in serious conditions like cancer where levels of important cells in your body such as red blood cells, white blood cells have dropped. Your condition is unlikely the result of a weakened immune system unless you have a report stating that your white blood cell count is lower than 4000.
You do have a few options which I would like to list out for you:

  1. Further treatment should be guided by urine culture results. Since you are now beginning to failure therapy with Bactrim, you can instead try a 12-week course of therapy with fluroquinolones ( ciprofloxacin at 500 mg or ofloxacin at 400 mg) administered twice daily or gatifloxacin/moxifloxacin at 400 mg given daily. This drug is particularly valuable if < 35 years and sexually active with multiple partners, because it also has activity against chlamydial and gonorrheal organisms.
  2. There is also an option to use other drugs such as carbenicillin or doxycycline or injections of gentamicin given IV or directly into the prostate.
  3. There are a few options to select from which may have to try out one at a time to see which one offers you relief. You can use terazosin at 1-10 mg OR Saw palmetto which is a herbal supplement OR quercetin which is found in green tea, onions and oranges.
  4. Daily sitz baths and perianal massage may help with the discomfort associated with chronic prostatitis.
  5. Surgery is usually not indicated for chronic prostatitis. However, in cases such as yours, TURP or TUVP may remove a nidus of infection. This nidus may be in the form of prostatic stones which are usually visible on transrectal ultrasonograms.
  6. Also it would be prudent to use protection from now onwards during sexual encounters so that an organism is not reintroduced and precipitate an attack.
Hope this helps, you can follow up with any queries that you may have,
Regards


Patient replied :

Dr
For the 2.5 years I have dealt with this it always is worst in early am (5-6) with a specific pointe of soreness 1inch or so to the lesft of my belly button and two inches down. When I awake this soreness is accompanied by considerable nausea. If I push on the spot it seems too have a connection to my prostate. This has occurred during last 2.5 years but would go away on bactrim when it worked and remain away for monthsI have had two colons copy's and barriuMm X-rays..gi is clear.
it seems to me as a lay person that either my nightly production of testosterone acts as an immunosuppressant although it should likely suppress inflammation too.
My last two PSA were 0.7 and 0.8
why am I sickest in the am and the pain expression more in abdomen than prostate.
prostare nerve.
i have taken 4 Advil at 3 am and it does not change the outcome. Usually the pain improves and nausea to some degree as day progresses. It often seems as though food helps the nausea

theories. Ideas.

thanks so much
ps if minocycline was sensitive would doxycycline be also? Minocycline caused hypothyroid and irregular heartbeat. Is ceftin anti mrsa?

Paul


Hello,
Thank you for the follow up Paul.
The morning soreness that you're feeling is most probably due to the overnight prostatic secretions those are accumulating and the pain is being referred to the abdomen. With a testosterone surge, the prostate secretions increase in the night time, providing a nidus for the bacteria to multiply.
I feel you should start yourself immdiately on Tab. Ofloxacin 400 mg twice daily for a 12 week course.
Doxycycline and minocycline are different. Minocycline can cross the blood brain barrier and cause more side effects. Doxy is more safer and better for urinary and prostatic infections.
I also advise you get sitz baths and peri anal massage regularly to get rid of the secretions, till you're on your antibiotics.
Yes Ceftin is 5th generation cephalosporin, active against MRSA.
Finally please do get the transrectal ultrasound and share your reports. Based on that i can guide you further
All the best.
Regards.


Patient replied :

You are unbelievabley knowledgeable and kind. Do you do videos conferencing and treat onlline?
I have no problem paying for more detailed consultation. Please advise.
I have orrginal diagnosis and susceptability and a trans rectal color utlrasound.
In order which would you say has best penetration and coverage, Oflaxacin, Doxocylcine and Ceftin.
I know Minocyline was tested for susceptability and was susceptible.

Thanks Again

Paul


Hello,
Thank you for your kind words Mr. Paul.
The only thing i want right now, is for you to get better as quickly as possible.
Unfortunately, i am not allowed to talk to via online skype consultations and these emails are the only source.
Whatever reports you have try uploading them here on your dashboard, or you can directly mail them to [email protected]
I will say purely on the basis of penetration and coverage, Doxycycline would be a better choice. Ceftin is also effective against MRSA, but it is used more in surgical prophylaxis cases. But if your sensitivity reports show Ceftin sensitive, then you can go ahead with it. I suggested Ofloxacin because compared to the other 2, it has the lowest side effects profile.
Wish you good health Paul!
Regards.


Patient replied :

Final quesiton for now. Sensitivity test shows Levaquine highly resistant ( would that not limit Oflaxin) It also indicates that mincocyline is susceptible. Would that likely mean doxcycline is susecpetible too. I might try it for 6 months.

Your thoughts?


No levofloxacin ( Levaquine ) and Ofloxacin are different drugs altogether.
They both are fluoroquinolones but they have separate bacteria profiles.
For example we never give Levoflox in UTI or prostatic infections.
We prescribe either Ofloxacin or Norflox.
However if you want to try Doxycycline, you can continue for 3 months, provided you're tolerating the drug well. Make sure you take probiotics along with it to avoid vitamin deficiency. All depends on how you tolerate it. If you're not tolerating it will then as an alternative start Ofloxacin and continue for 3 month. Drug wise Doxy is more stronger with a wider spectrum but patients complain mostly of gastric side effects.
So entirely depends on how you tolerate it.
Hope i have been helpful,
Regards.


Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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