The Efficacy of Antibiotic and α–Blocker Combination Therapy versus Antibiotic Monotherapy in Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Systematic Review

Abstract

Abstract Objective This study attempted to explore an alpha-blocker regimen's efficacy and antibiotics versus antibiotics as monotherapy in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Methods We searched the PubMed/MEDLINE, Cochrane/CENTRAL, EBSCOHost/CINAHL, ProQuest, and Scopus with specific keywords adjusted to each search engine on January 2020. Randomized controlled trials comparing antibiotics monotherapy with combination therapy of antibiotics and alpha-blockers in CP/CPPS patients, lasting at least four weeks, was included in the study. The study eligibility assessment, data extraction, and study quality assessment were carried out by each author independently and in duplication. Results A total of six low to high-quality studies, with 396 patients participating in the study. Two reviews reported lower NIH-CPSI total scores in the monotherapy arm at week six. Only one study reported otherwise. On day 90, the NIH-CPSI score was found to be lower in the combination group. In the pain, urinary, and quality of life domain, most studies agree that combination therapy is not superior to monotherapy. However, on day 90, all domains were found to be lower in the combination therapy arm. Responder rates were found to vary between studies. Only four out of six studies reported a response rate. Responder rates were lower in the combination group at six weeks of observation. On day 90, responder rates were found to be better in the combination group. Conclusion The combination therapy of antibiotics and alpha-blocker therapy is not substantially better than antibiotic monotherapy in the first six weeks of treatment for CP/CPPS patients. This result might not be applicable in a longer duration of treatment.