Alexander RB et al. (2004) Ciprofloxacin or tamsulosin in men with chronic prostatitis/chronic pelvic pain syndrome. Ann Intern Med 141: 581–589

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)—characterized by pain or discomfort in the pelvic region lasting more than 3 months—is difficult to treat because its cause is unknown. Antibiotic therapy with agents such as ciprofloxacin is widely used, even though there is frequently no infection of the prostate. Alternatively, α-blockers such as tamsulosin are often prescribed. A new study by Alexander et al. has compared these treatments with placebo in men with long-standing symptoms of CP/CPPS.

A total of 196 patients, all of whom had received prior treatment for CP/CPPS, were randomly assigned to ciprofloxacin (500 mg twice daily), tamsulosin (0.4 mg once daily), both drugs, or placebo, with 49 patients in each group. After 6 weeks' treatment, all treatment groups showed a slight decrease in NIH-CPSI scores compared to baseline, but neither drug showed a significant difference compared with placebo. Secondary outcomes, including changes in the quality-of-life, pain and voiding subscales of the NIH-CPSI, were also similar in all treatment groups.

Alexander et al. conclude that ciprofloxacin and tamsulosin, both common treatments for CP/CPPS, were not effective in this study. It is possible that including patients who were naïve to treatment and/or extending the duration of therapy might result in improved symptom scores. The authors note, however, that the design of the study reflected current practice.