The Bacterial Inhibitory Ability and In Vivo Drug Release Pattern of a New Drug Delivery System:Ciprofloxacine/tricalcium Phosphate Delivery Capsule

The bacterial inhibitory ability of a new drug delivery system (DDS):Ciprofloxacine/tricalcium phosphate delivery capsule (CTDC), its in vivo drug release pattern, and the influence of ultrasonic irradiation on its drug release were investigated. It was found that CTDC had a strong and sustained inhibitory ability to some common pathogens of bone and joint infections, such as staphylococcus aureus, escherichia coli and pseudomonas aeruginosa. In vivo drug-release study in animals demonstrated a high concentration of ciprofloxacine in the bone tissue surrounding CTDC which was placed in the greater trochanter of the rabbit and continued to release ciprofloxacine for at least 5 weeks and the blood level of ciprofloxacine was low. In vivo study also showed ultrasonic irradiation could increase the amount of ciprofloxacine released from CTDC, which may be an economical, effecient and safe new method to achieve the control of drug release from DDS.

Pharmacokinetics of Enrofloxacin and Its Metabolite in Carp (Cyprinus carpio) After a Single Oral Administration in Medicated Feed

A precise and reliable analytical method of high performance liquid chromatography-tandem mass spectrometry(HPLCMS/MS)was developed to measure trace levels of enrofloxacin(ENR)and its major metabolite ciprofloxacin(CIP)in carp tissues.Optimized chromatographic separation was obtained on a Waters Xterra MS C_(18) reversed-phase column using gradient elution with methanol and 0.1%formic acid aqueous solution including 5mmolL^(-1) of ammonium acetate.The established method was applied to study the pharmacokinetics and distribution of ENR and CIP in tissues of carp following a single oral administration in feed at a dosage of 40mgkg^(-1) bw(body weight).Data were analyzed using DAS 2.0 dynamics software,and the experimental results suggest that ENR was rapidly absorbed and extensively distributed in carp tissues through systemic circulation,and the pharmacokinetic characteristics can be described with a two-compartment model.The elimination half-lives(t_(1/2β))from muscle,liver,gill,plasma and skin were 131,160,104,132 and 310 h,respectively.The areas under the drug concentration-time curves(AUC)for these tissues were 491,972,750,249 and 706hmgkg^(-1),respectively.The maximum concentration(C_(max))values were 13,29,37,9 and 5mgkg^(-1) with peak times(t_(max))of 8,4,4,2 and 4 h,respectively.Ciprofloxacin,the active metabolite of ENR,was also detected in carp tissues,indicating that only 1.54%of de-ethylation of ENR occurs in carp.At a water temperature of 18℃,the drug withdrawal time was determined to be no less than 24 d while the carp was fed at a single dosage of 40mgkg^(-1).

Oxidation of ciprofloxacin by the synergistic effect of DBD plasma and persulfate:reactive species and influencing factors analysis

A synergistic system of water falling film dielectric barrier discharge(DBD)plasma and persulfate(PS)was set up and used for oxidizing ciprofloxacin(CIP)in water.Results of reactive species formation in the DBD-only system as well as the DBD–PS system verified the PS activation in the DBD system.Influencing factors on CIP degradation and the degradation process were also been studied.The obtained results showed that the presence of PS could greatly improve the degradation and mineralization of CIP and that the degradation efficiency could reach 97.73%after only 40 min treatment with 4 m M PS addition.The increase of PS concentration,the lower CIP concentration,the acidic solution p H and the addition of metal ions(Fe^(2+)and Cu^(2+))enhanced the CIP degradation,while the existence of Cl^(-)and HCO_(3)^(-)had a negative effect.The experiments related to scavenger addition confirmed the contribution of the main reactive species to the CIP oxidation.Three probable degradation pathways were proposed by analyzing the inorganic ions and organic byproducts formed during the CIP degradation.The toxicity evaluation results of the CIP and its intermediates confirmed the effectiveness of the DBD–PS synergistic system.

Preparation of sodium alginate gel microspheres catalysts and its high catalytic performance for treatment of ciprofloxacin wastewater

The discharge of the antibiotic wastewater has increased dramatically in our country with the development of medical science and wide application of antibiotic,resulting in serious harm to human body and ecological environment.In this work,ciprofloxacin(CIP)was selected as one of typical antibiotics and heterogeneous Fenton-like catalysts were prepared for the treatment of ciprofloxacin wastewater.The sodium alginate(SA)gel microspheres catalysts were prepared by polymerization method using double metal ions of Fe^(3+)and Mn^(2+)as cross-linking agents.Preparation conditions such as metal ions concentration,mass fraction of SA,polymerization temperature and dual-metal ions as crosslinking agent were optimized.Moreover,the effects of operating conditions such as initial concentration of CIP,pH value and catalyst dosage on CIP removal were studied.The kinetic equation showed that the effect of the initial concentration of CIP on the degradation rate was in line with second-order kinetics,and the effects of catalyst dosage and pH value on the degradation rate of CIP were in line with first-order kinetics.The SA gel microspheres catalysts prepared by dual-metal ions exhibited a high CIP removal and showed a good reusability after six recycles.The SA gel microspheres catalysts with an easy recovery performance provided an economical and efficient method for the removal of antibiotics in the future.

Recurrent ciprofloxacin induced hypoglycemia in a non-diabetic patient:A case report

BACKGROUND Fluoroquinolones are a class of broad-spectrum antimicrobials used for various bacterial infections.Frequent use of fluoroquinolones has been questioned due to severe associated adverse effects,including dysglycemia(hypoglycemia or hyperglycemia)due to an alternation in glucose metabolism.Recent clinical trials showed the association of poor clinical outcomes with hypoglycemia in critically ill patients without diabetes.Many predisposing factors worsen fluoroquinolone-induced hypoglycemia,including diabetes,concomitant medication use like sulfonylureas or insulin,renal disease,and the elderly.CASE SUMMARY We report a case of recurrent hypoglycemia after ciprofloxacin initiation for a 71-year-old,non-diabetic,critically ill patient despite the presence of total parenteral nutrition and nasogastric tube feeding.The adverse drug reaction probability(Naranjo)scale was completed with a probable adverse drug reaction.The hypoglycemia resolved entirely after ciprofloxacin discontinuation.CONCLUSION Although ciprofloxacin-induced hypoglycemia is rare,special consideration is needed for the elderly due to their higher susceptibility to adverse side effects.

氟喹诺酮类抗菌药与其他药物的相互作用

目前,临床评价很高的一类抗菌新药——氟喹诺酮类,如氟哌酸(NorfloxacinNOR)、氟嗪酸(Ofloxacin OFLO)、氟啶酸(Enoxacin ENO)、和环丙氟哌酸(Ciprofloxacin CIP)等。此类药物抗菌谱广,抗菌活性强,不仅对G^-和G^+细菌有极强的杀菌作用,而且对耐第三代头孢菌素,耐广谱抗生素,耐新的氨基糖苷类药的病原体,均有优异的效果,同时与抗生素无交叉耐药性。

如何撰写医学论文的英文摘要

笔者日常编辑工作中,经常遇到许多作者的英文摘要不符合写作要求,达不到促进学术交流的目的。现从医学杂志编辑的角度,对英文摘要的写法做一些粗浅探讨.

用Ciprofloxacin去除传代细胞株中的支原体污染的研究

在应用细胞培养手段的生物学研究和生物工程产品中,支原体污染仍是一个非常棘手的问题。对Vero和SP 2/0-Ag 14等细胞,应用Ciprofloxacin,10μg/ml处理14天,支原体检测全部转阴,经4个月的培养、传代、冻存、复苏,每次支原体检测均保持阴性。对去除了支原体的Vero和LSC-116细胞株,测试了其生长特征和功能,均未见受影响。

Safety and efficacy of levofloxacin versus ciprofloxacin for the treatment of chronic bacterial prostatitis in Chinese patients

Levofloxacin is a synthetic fluoroquinolone that is usually used to treat chronic bacterial prostatitis. We investigated the safety and efficacy of levofloxacin compared with ciprofloxacin for the treatment of chronic bacterial prostatitis in Chinese patients. This was a multicenter, open-label, randomized controlled non-inferiority trial. Four hundred and seventy-one patients with clinical symptoms/ signs were enrolled into the study, and 408 patients were microbiologically confirmed chronic bacterial prostatitis, who were randomized to either oral levofloxacin （500 mg q,d.） or ciprofloxacin （500 mg b.i^d.） for 4 weeks. Bacterial clearance rate, clinical symptoms/signs, adverse reactions and disease recurrence were assessed. The clinical symptoms and signs （including dysuria, perineal discomfort or pain） and bacteria cultures in 209 patients treated with levofloxacin and 199 patients treated with ciprofloxacin were similar. The most common bacteria were Escherichia cofiand Staphylococcus aureus. One to four weeks after the end of 4 weeks treatment, the bacterial clearance rate （86.06% vs. 60.03%; P〈O.05） and the clinical efficacy （including clinical cure and clinical improvement（93.30% vs. 71.86%; P〈0.05）） were significantly higher in the levofloxacin-treated group than in the ciprofloxacin-treated group. The microbiological recurrence rate was significantly lower in the levofloxacin-treated group than in the ciprofloxacin-treated group （4.00% vs. 19.25%; P〈0.05）. Rates of adverse events and treatment-related adverse events were slightly lower in the levofloxacin-treated group than in ciprofloxacin-treated group. Levofloxacin showed some advantages over ciprofloxacin in terms of clinical efficacy and disease recurrence, with a low rate of adverse events, for the treatment of chronic bacterial prostatitis in Chinese patients.

Construction of TiO_(2)-pillared multilayer graphene nanocomposites as efficient photocatalysts for ciprofloxacin degradation

We successfully constructed TiO_(2)-pillared multilayer graphene nanocomposites(T-MLGs)via a facile method as follows:dodecanediamine pre-pillaring,ion exchange(Ti4+pillaring),and interlayer in-situ formation of TiO_(2) by hydrothermal method.TiO_(2) nanoparticles were distributed uniformly on the graphene interlayer.The special structure combined the advantages of graphene and TiO_(2) nanoparticles.As a result,T-MLGs with 64.3wt%TiO_(2) showed the optimum photodegradation rate and adsorption capabilities toward ciprofloxacin.The photodegradation rate of T-MLGs with 64.3wt%TiO_(2) was 78%under light-emitting diode light irradiation for 150 min.Meanwhile,the pseudofirst-order rate constant of T-MLGs with 64.3wt%TiO_(2) was 3.89 times than that of pristine TiO_(2).The composites also exhibited high stability and reusability after five consecutive photocatalytic tests.This work provides a facile method to synthesize semiconductor-pillared graphene nanocomposites by replacing TiO_(2) nanoparticles with other nanoparticles and a feasible means for sustainable utilization of photocatalysts in wastewater control.

Fluoroquinolone-macrolide combination therapy for chronic bacterial prostatitis： retrospective analysis of pathogen eradication rates, inflammatory findings and sexual dysfunction

We previously demonstrated the safety and efficacy of fluoroquinolone-macrolide combination therapy in category Ⅱ chronic bacterial prostatitis （CBP）. The aim of this study is to retrospectively compare the microbiological and clinical findings of two treatment schemes for CBP based on the combination of azithromycin （500 rag, thrice-weekly） with a once-daily 500- or 750-mg dose of ciprofloxacin （Cipro-500 or Cipro-750 cohort, respectively）. Combined administration of azithromycin （1500 mg week^-1） with ciprofloxacin at the rate of 750 mg day^- 1 for 4 weeks rather than at 500 mg day^- 1 for 6 weeks increased the eradication rates from 62.35% to 77.32% and the total bacteriological success from 71.76% to 85.57%. A significant decrease in pain and voiding signs/symptoms and a significant reduction in inflammatory leukocyte counts and serum prostate-specific antigen （PSA） were sustained throughout an 18-month follow-up period in both groups. Ejaculatory pain, haemospermia and premature ejaculation were significantly attenuated on microbiological eradication in both groups, but the latter subsided more promptly in the Cipro-750 cohort. In total, 59 Cipro-750 patients showed mild-to-severe erectile dysfunction （ED） at baseline, while 22 patients had no ED on microbiological eradication and throughout the follow-up period. In conclusion fluoroquinolone-macrolide therapy resulted in pathogen eradication and CBP symptom attenuation, including pain, voiding disturbances and sexual dysfunction. A once-daily 750-mg dose of ciprofloxacin for 4 weeks showed enhanced eradication rates and lower inflammatory white blood cell counts compared to the 500-mg dose for 6 weeks. Our results are open to further prospective validation.

Synthesis and Crystal Structure of Rare Earth Complex withCiprofloxacin

The complex of rare earth with ciprofloxacin has been synthesized and characterized by means of x-ray single crystal diffraction. The structure features of the complex are decribed.

A granular adsorbent-supported Fe/Ni nanoparticles activating persulfate system for simultaneous adsorption and degradation of ciprofloxacin

In this work,Fe/Ni nanoparticles were produced through Fe(II)and Ni(II)reduction by NaBH4 and they were stabilized by a kind of prepared granular adsorbent(Fe/Ni@PGA).Fe/Ni@PGA as an environment-friendly activator was used to activate persulfate(PS)for the removal of ciprofloxacin from aqueous solution.Fe/Ni@PGA was systematically characterized via Brunauer-Emmett-Teller(BET)method,X-ray diffraction(XRD),scanning electron microscopy(SEM),and Fourier transform infrared spectroscopy(FTIR).The effects of PS concentration,initial solution pH,Fe/Ni@PGA dosage,initial ciprofloxacin concentration,reaction temperature,anions,and natural organic matters on the removal of ciprofloxacin by Fe/Ni@PGA/PS were analyzed.The removal efficiency of ciprofloxacin by Fe/Ni@PGA/PS was 93.24%under an initial pH of 3.0,PS concentration of 10 mM,Fe/Ni@PGA dosage of 0.1 g,and reaction temperature of 30℃.Fe/Ni@PGA could still exhibit high catalytic activity after nine cycles of regeneration.The removal mechanisms for ciprofloxacin by the Fe/Ni@PGA/PS system were proposed.In summary,the Fe/Ni@PGA/PS system could be applied as a promising technology for ciprofloxacin removal.

Prior exposure to ciprofloxacin disrupts intestinal homeostasis and predisposes ayu(Plecoglossus altivelis)to subsequent Pseudomonas plecoglossicida-induced infection

With the rapid development of intensive farming,the aquaculture industry uses a great many antibiotics for the prevention and treatment of bacterial diseases.Despite their therapeutic functions,the overuse and accumulation of antibiotics also pose a threat to aquaculture organisms.In the present study,ayu(Plecoglossus altivelis)was used as a fish model to study the impacts of ciprofloxacin(CIP)overuse on intestinal homeostasis and immune response during subsequent Pseudomonas plecoglossicida infection.Based on 16S rRNA gene amplification and Illumina sequencing,we found that CIP pre-exposure caused significant variation in intestinal microbiota,including increased species richness,altered microbiota composition and interaction networks,and increased metabolic dysfunction.Furthermore,immunohistochemical analysis indicated that CIP pre-exposure resulted in severe mucosal layer damage,goblet cell reduction,and epithelial cell necrosis of the intestinal barrier in infected ayu.Quantitative real-time polymerase chain reaction(qRT-PCR)showed that disruption of intestinal homeostasis impaired systemic antiinfection immune responses in the intestine,gill,spleen,and head kidney,while inhibiting IL-1β,TNF-α,and IL-10 expression and promoting TGF-βexpression.Our findings indicated that CIP administration can directly affect intestinal microbiota composition and intestinal integrity in ayu fish.This perturbation of intestinal homeostasis is likely responsible for the lower survival rate of hosts following subsequent infection as the capacity to mount an effective immune response is compromised.This study also provides preliminary clues for understanding the effects of antibiotic overuse on higher vertebrates through trophic transfer.

Infective severe acute pancreatitis:A comparison of ^(99m)Tc-ciprofloxacin scintigraphy and computed tomography

AIM:To evaluate 99mTc-ciprofloxacin scintigraphy compared with computed tomography(CT)for detecting secondary infections associated with severe acute pancreatitis(SAP)in swine.METHODS:Six healthy swine were assigned to a normal control group(group A,n = 6).SAP was induced in group B(n = 9)and C(n = 18),followed by inoculation of the resulting pancreatic necroses with inactive Escherichia coli(E.coli)(group B)and active E.coli(group C),respectively.At 7 d after inoculation,a CT scan and a series of analyses using infecton imaging(at 0.5,1,2,3,4 and 6 h after the administration of 370 MBq of intravenous infecton)were performed.The scintigrams were visually evaluated and semi-quantitatively analyzed using region of interest assignments.The differences in infecton uptake and changes in the lesion-background radioactive count ratios(L/B)in the 3 groups were recorded and compared.After imaging detection,histopathology and bacterial examinations were performed,and infected SAP was regarded as positive.The imaging findings were compared with histopathological and bacteriological results.RESULTS:In group A,6 animals survived without infection in the pancreas.In group B,7/9 swine survived and one suffered from infection.In group C,15/18 animals survived with infection.Hence,the number of normal,non-infected and infected SAP swine was 6,6 and 16,respectively.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the infecton method were 93.8%(15/16),91.7%(11/12),92.9%(26/28),93.8%(15/16)and 91.7%(11/12),whereas these values for CT were 12.5%(2/16),100.0%(12/12),50.0%(14/28),100.0%(2/2)and 46.2%(12/26),respectively.The changes in L/B for the infected SAP were significantly different from those of the non-infected and normal swine(P < 0.001).The mean L/B of the infectious foci at 0.5,1,2,3,4 and 6 h was 1.17 ± 0.10,1.71 ± 0.30,2.46 ± 0.45,3.36 ± 0.33,2.04 ± 0.37 and 1.1988 ± 0.09,respectively.At 3 h,the radioactive counts(2350.25 ± 602.35 k)and the mean L/B of the infectious foci were significantly higher than that at 0.5 h(P = 0.000),1 h(P = 0.000),2 h(P = 0.04),4 h(P = 0.000)and 6 h(P = 0.000).CONCLUSION:99m Tc-ciprofloxacin scintigraphy may be an effective procedure for detecting SAP secondary infections with higher sensitivity and accuracy than CT.

Antimicrobial activity and synergism of Sami-Hyanglyun-Hwan with ciprofloxacin against methicillin-resistant Staphylococcus aureus

Objective: To investigate the antibacterial activity of SHHextracted with either water or ethanol against methicillin-resistant Staphylococcus aureus(MRSA) and combinatory antimicrobial effect with ciprofloxacin(CIP) by time kill assay and checkerboard dilution test. Methods: The antibacterial activity determined by broth dilution method indicated that the antibacterial activity of Sami-Hyanglyun-Hwan(SHH) water extract(SHHW) and SHH ethanol extract(SHHE) ranged from 250 to 2000 μg/m L and 125 to 1000 μg/m L against MRSA, respectively. Results: In the checkerboard method, the combinations of SHHE with CIP had a partial synergistic or synergistic effect against MRSA. The time-kill curves showed that a combined SHHE and CIP treatment reduced the bacterial counts dramatically after 24 h. Conclusions: The present study demonstrates the therapeutic ability of SHHE against MRSA infections.

Presence and Antimicrobial Susceptibility of RE-cmeABC-Positive Campylobacter Isolated from Food-Producing Animals, 2014–2016

Campylobacter spp. are the leading cause of human gastroenteritis worldwide. RE-CmeABC is a newly identified resistance-enhancing multidrug efflux pump of Campylobacter spp. (C. spp.) that confers high-level resistance to fluoroquinolones, phenicols, macrolides, and tetracyclines (TETs), all of which are critical drugs in both human and veterinary medicine. In this study, we analyzed the presence and antimicrobial susceptibility of RE-cmeABC-positive Campylobacter isolates of food-animal origin from three representative regions (Shandong, Shanghai, and Guangdong) in China over three successive years, from 2014 to 2016. A total of 1088 Campylobacter isolates (931 C. coli and 157 C. jejuni) were recovered from the RE-cmeABC screening. We detected 122 (11.2%) RE-cmeABC-positive isolates of chicken origin, including 111 (70.7%) C. jejuni and 11 (1.2%) C. coli. This multidrug efflux pump is more prevalent among C. jejuni than C. coli. The level of resistance was significantly different in 111 RE-cmeABC-positive C. jejuni versus 46 RE-cmeABC-negative C. jejuni for florfenicol, clindamycin, and erythromycin (P < 0.05), but not for ciprofloxacin (CIP), TET, and gentamicin (GEN). However, the isolates harboring RE-cmeABC could shift the minimum inhibitory concentration distribution to the higher range for CIP and TET. Pulsed-field gel electrophoresis (PFGE) analysis suggested that horizontal transmission might be involved in the dissemination of RE-cmeABC in Shanghai and Guangdong, while clonal expansion was predominant in Shandong. Three isolates shared the indiscriminate PFGE types of RE-cmeABC-positive C. jejuni isolates in Shanghai and Guangdong, and four isolates in Shanghai and Shandong. Our study suggests the possibility of a wide dissemination of RE-cmeABC in Campylobacter of food-animal origin, which would pose a significant threat to public health.

Taste masking of ciprofloxacin by ion-exchange resin and sustain release at gastric-intestinal through interpenetrating polymer network

The aim of the study was to taste mask ciprofloxacin(CP)by using ion-exchange resins(IERs)followed by sustain release of CP by forming interpenetrating polymer network(IPN).IERs based on the copolymerization of acrylic acid with different cross linking agents were synthesised.Drug-resin complexes(DRCs)with three different ratios of drug to IERs(1:1,1:2,1:4)were prepared&evaluated for taste masking by following in vivo and in vitro methods.Human volunteers graded ADC 1:4,acrylic acid-divinyl benzene(ADC-3)resin as tasteless.Characterization studies such as FTIR,SEM,DSC,P-XRD differentiated ADC 1:4,from physical mixture(PM 1:4)and confirmed the formation of complex.In vitro drug release of ADC 1:4 showed complete release of CP within 60 min at simulated gastric fluid(SGF)i.e.pH 1.2.IPN beads were prepared with ADC 1:4 by using sodium alginate(AL)and sodium alginate-chitosan(AL-CS)for sustain release of CP at SGF pH and followed by simulated intestinal fluid(SIF i.e.pH 7.4).FTIR spectra confirmed the formation of IPN beads.The release of CP was sustain at SGF pH(<20%)whereas in SIF media it was more(>75%).The kinetic model of IPN beads showed the release of CP was non-Fickian diffusion type.

Interaction of ciprofloxacin hydrochloride with sodium dodecyl sulfate in aqueous/electrolytes solution at different temperatures and compositions

Interactions of ciprofloxacin hydrochloride(CPFH)with sodium dodecyl sulfate(SDS)were investigated by conductivity measurement in H2O/electrolyte solutions(NaCl,Na2SO4&Na3PO4)over 298.15–318.15 K temperature range(with 5 K interval)considering the human body temperature.In all cases,two critical micelle concentrations(c*)were observed which are increased in the presence of drug and decreased in the presence of salts enunciating the presence of interaction amongst the studied components.For(CPFH+SDS)system in the presence of salt,the c*values at 303.15 K and I=0.50 mmol·kg^-1 followed the order:CNaCl>CNa2SO4>CNa3PO4.TheΔG1,m0 andΔG2,m0values are found to be negative for all systems that show that the micellization process is thermodynamically spontaneous.For(CPFH+SDS)system in water,theΔHm0&ΔSm0 values reveal that the micellization processes is both entropy dominated in almost all cases.In the occurrence of electrolytes,ΔHm0 andΔSm0 values indicate that micellization processes are both entropy&enthalpy restricted at upper temperature but it becomes totally entropy dependent at higher temperature.The higher positiveΔSm0 values indicate the enhanced hydrophobic interaction in presence of salts.The enthalpy-entropy compensation was determined from the linear relationship betweenΔHm0 andΔSm0 values in every state.Different transfer energies as well as compensation temperature and intrinsic enthalpy were also evaluated and the behaviors were comparable to other biological system.

Semen analysis in chronic bacterial prostatitis： diagnostic and therapeutic implications

The significance and diagnostic value of semen analysis in chronic bacterial prostatitis has been extensively debated and remains controversial. To investigate the diagnostic relevance of semen culture in the bacteriological workup of prostatitis patients, we retrospectively analyzed a clinical database of 696 symptomatic patients. All patients were routinely subjected to a four-glass test, followed by semen culture and analysis. This allowed to dissect from the database three different diagnostic scenarios, and to compare the ＇two-glass＇ pre-/post- massage test and the standard ＇four-glass＇ test with a ＇five-glass＇ test （four-glass plus post-VB3 semen culture）. The ＇five-glass＇ test showed 3.6- or 6.5-fold increases in relative sensitivity and lesser reductions （-13.2% or -14.7%） in relative specificity for traditional uropathogens （TUs） compared with the four-glass or two-glass test, respectively. The area under the ROC curve and Jouden＇s index were increased, whereas positive and negative likelihood ratios were lower than comparators, indicating that the ＇five-glass＇ assay may be superior in confirming the negative outcome of both standard tests. The five-, four-, and two-glass tests detected TUs （Enterobacteriaceae, Enterococci, etc.） in 120, 33, and 20 patients and unusual pathogens （Streptococci, other Gram-positive species, Mycoplasmata, and others） in 130, 56, and 45 patients, respectively. When patients were subjected to pharmacological treatment, including a combination of a fluoroquinolone and a macrolide, no differences in eradication rates were observed between groups diagnosed with different tests, irrespective of pathogen category. Eradication was associated with long-term sign/symptom remission; no significant intergroup differences in sign/symptom scores were observed throughout a 24-month off-therapy follow-up period. In conclusion, our data support the usefulness of semen analysis in the diagnostic workup ofprostatitis patients when this test is used to complement the four-glass Meares and Stamey test. Improvement of microbiological assays conveys important diagnostic and therapeutic implications.