Re: Effectiveness of antibiotics given to asymptomatic men for an increased prostate specific antigen. S. Baltaci, E. Suer, A. H. Haliloglu, M. I. Gokce, A. H. Elhan and Y. Beduk. J Urol 2009; 181: 128-132.

摘要

Our impression is similar to that of the authors-prescribing an empirical course of antibiotic therapy to asymptomatic men with an increased prostate specific antigen (PSA) level is common clinical practice. While we are not aware of data ronfirming this supposition, there is certainly a lack of objective evidence to support this practice. Given the prevalence of men with an increased PSA and the potential risks associated with injudicious quinolone administration (drug interactions, microbial resistance, tendinopathies), until supporting evidence is available we and others disagree with this treatment algorithm.The authors should be commended for attempting to address this important clinical scenario. Furthermore, we laud them for performing prostate biopsies in all patients irrespective of posttreatment PSA levels, a limitation of some earlier, similarly designed studies. However, we believe that methodological flaws prevent meaningful conclusions from being obtained. Specifically the authors report decreases in PSA levels following a course of antibiotics. However, without a placebo controlled group, or at least a group not given antibiotics, it is impossible to determine whether this change is due to natural PSA variability, regression toward the mean or the antibiotic itself.