I am a 29-year-old male. I have been complaining of symptoms of prostatitis for seven years with LUTS, fatigue, and pain as the main symptoms. The EPS shows more than 10 WBC per HPF and urine and prostatic cultures are negative. Semen culture was done twice in the last six months with the first one showing high agglutination and the second one done three months after is completely normal. I had three courses of antibiotics. Two Levofloxacin and one Ciprofloxacin with a duration of one month to six weeks each time. Antibiotics show partial improvement. I am having a relapse now with pain along the epididymis and when bending down and walking, which happened before and showed improvement only on Levofloxacin.
My question is regarding the new data about the safety of Levofloxacin with reported potentially permanent muscular and CNS effects. Should I change antibiotic this time? And what about Fosfomycin?
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You are suffering from chronic prostatitis. It is very difficult to treat. Ideally, prostatic massage and EPS or semen culture must be done. But, if you have an improvement with Levofloxacin, then you can take it. The side effects are if you take it for a very long duration in years.
For an acute episode as now take Levofloxacin. Then later, you can shift to oral low dose Nitrofurantoin 100 mg daily for three months. I would also like to add Doxycycline (with Levofloxacin) 100 mg bd for 14 days for an atypical organism. Fosfomycin is reserved in case you have resistance with other drugs. So do not use now.
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