Prostatitis accounts for 2 million outpatient visits annually. The majority of prostatitis cases fit the definition of chronic pelvic pain syndrome, for which routine antibiotic use is not indicated.
Methods
Inpatient, outpatient, and pharmacy datasets from the Veterans Health Administration were used to quantify the magnitude of antibiotic use attributable to chronic pelvic pain syndrome. Specifically, men with a diagnosis of infectious/acute prostatitis or a urinary tract infection were excluded, and the remaining men with a diagnosis of prostatitis were defined as having chronic pelvic pain syndrome.
Results
The annual prevalence of chronic pelvic pain syndrome was 0.5%. Prescriptions for fluoroquinolone antibiotics were filled in 49% of men with a diagnosis of chronic pelvic pain syndrome compared with 5% in men without chronic pelvic pain syndrome. Men with chronic pelvic pain syndrome were more than 7 times more likely to receive a fluoroquinolone prescription independently of age, race/ethnicity, and comorbid conditions. Increased use of other antibiotics also was observed. High use was similar in men with either infectious/acute prostatitis or chronic pelvic pain syndrome.
Conclusion
Despite evidence that antibiotics are not effective in the majority of men with chronic pelvic pain syndrome, they were prescribed in 69% of men with this diagnosis. Some increased use is probably due to uncontrolled confounding by comorbid conditions or inaccurate diagnostic coding. However, a 7-fold higher rate of fluoroquinolone usage suggests that strategies to reduce unnecessary antibiotic use in men with prostatitis are warranted.
fCenter for Management of Complex Chronic Care, Hines VA Hospital, Hines, Ill
gInstitute for Healthcare Studies, Northwestern University, Chicago, Ill
hTemple University School of Medicine, Philadelphia, Pa.
Requests for reprints should be addressed to Timothy J. Wilt, MD, MPH, Center for Chronic Disease Outcomes Research (111-0), Minneapolis VA Medical Center, 1 Veterans Drive, Minneapolis, MN 55417.
Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the National Institutes of Health.
This study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIH-NIDDK 1DK-351601). The authors also gratefully acknowledge support from the Department of Veterans Affairs, Veterans Health Administration, and Office of Health Services Research and Development for providing support for the VA Information Resource Center and for postdoctoral fellowship funding support of Dr Taylor.
ABSTRACT
