Is hyperbaric oxygen therapy (HBOT) beneficial when treating chronic bacterial prostatitis caused by Enterococcus (E.) Faecalis with amoxicillin (amoxicillin)?

Hyperbaric Oxygen Therapy Is Not Recommended for E. Faecalis Chronic Bacterial Prostatitis Treatment with Amoxicillin

Hyperbaric oxygen therapy (HBOT) is not recommended as an adjunctive treatment for chronic bacterial prostatitis caused by Enterococcus faecalis when using amoxicillin, as there is no evidence supporting its use for this specific condition.

Current Evidence on HBOT for Bacterial Infections

• HBOT involves breathing 100% oxygen at pressurized atmospheres (typically 2-3 ATA), which increases oxygen partial pressure in tissues 1
• HBOT has theoretical benefits including improved leukocyte function, inhibition of anaerobic bacterial growth, inhibition of toxin production, and enhancement of antibiotic activity 1
• Current guidelines only conditionally recommend HBOT for specific conditions such as:
  • Neuro-ischemic or ischemic diabetic foot ulcers where standard care has failed 1
  • Necrotizing soft tissue infections as an adjunctive therapy after prompt surgical debridement 1

E. Faecalis in Chronic Bacterial Prostatitis

• E. faecalis is one of the most common pathogens associated with chronic bacterial prostatitis 2, 3
• The diagnosis of chronic bacterial prostatitis requires the Meares and Stamey 2- or 4-glass test as recommended by European Association of Urology guidelines 1
• E. faecalis strains in chronic bacterial prostatitis have shown various resistance patterns, with studies showing:
  • Low resistance to ampicillin (0%) and amoxicillin/sulbactam (0%) 2
  • Higher resistance to other antibiotics including erythromycin (95%), tetracycline (97.5%), and trimethoprim/sulfamethoxazole (31.5%) 2

Treatment Recommendations for E. Faecalis Prostatitis

• Fluoroquinolones are generally preferred antibiotics for treating chronic bacterial prostatitis due to their favorable pharmacokinetic profile and low resistance rates for E. faecalis 2
• When using amoxicillin for E. faecalis prostatitis:
  • Extended therapy (4-16 weeks) is typically required due to the difficulty in achieving therapeutic levels in the prostatic secretory system 3
  • No evidence supports adding HBOT to amoxicillin therapy for this specific condition

Limitations of HBOT for Prostatitis Treatment

• There are no clinical studies or guidelines supporting HBOT use specifically for chronic bacterial prostatitis 1
• HBOT has significant practical limitations:
  • High cost and limited availability 1, 4
  • Requires specialized equipment and facilities 4
  • Time-consuming treatment protocol requiring weeks of intense therapy 1
  • Potential side effects including barotrauma of the middle ear or sinuses, transient myopia, and claustrophobia 4

Alternative Approaches for E. Faecalis Prostatitis

• For cases of E. faecalis prostatitis resistant to conventional antibiotics:
  • Bacteriophage therapy has shown promising results in case reports where antibiotics failed 5, 6
  • Phage therapy has demonstrated effectiveness in eradicating E. faecalis in chronic bacterial prostatitis with clinical symptom improvement 6

Conclusion

While HBOT has demonstrated benefits in specific conditions like diabetic foot ulcers and necrotizing soft tissue infections, there is no evidence supporting its use for chronic bacterial prostatitis caused by E. faecalis. Treatment should focus on appropriate antibiotic therapy with agents that achieve adequate prostatic tissue concentrations. For resistant cases, alternative approaches like bacteriophage therapy may be considered based on emerging evidence.