Urology Expert Forum
reaction to antibiotics
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reaction to antibiotics

two years ago I had my semen cultured because of symptoms of prostititis and had a positive culture for Enterococcus Faecalis, and went on antibiotics for a month.  Because of a diagnosis of Non-Hodgkins Lymphoma and 6 months of treatments we never re cultured my semen.  Because of recurring relatively minor symptoms my semen was cultured again a month ago, and again a positive culture of Enterococcus Faecalis.  A month of Amoxicillan (875 mg- 2 x per day) and Rifampin (300mg 2 x per day) was prescribed but within 24 hours I was experiencing nausea and headaches.  Although prilosec (daily) and advil 2-3 times daily helped enough to allow me to work and function it was not tenable, and so my doctor said to discontinue the Rifampin after day 6 hoping that was causing the reaction.  Now, 36 hours after discontinuing the Rifampin I still have mild nausea and headache, which would difficult ot sustain for 3 more weeks.  
1. How would you proceed vis a vis a different antibiotic and
2. are you aware of any alternative therapies that might resolve problem,
3. Can a healthy prostate have bacteria in a semen culuture?
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I would stop all antibiotics and if your GI symptoms did not resolve in a day or two, I’d look for another, possibly more serious cause for these symptoms. Rifampin has been known to cause liver, renal and pancreatic problems, though not commonly.
Semen is usually sterile and represents fluids from your testis, epididymis, vas deferens, prostate and urethra. Therefore, let us not only give attention to your prostate. I would want to know about your urine culture also. As to treatment, I’d need to see the sensitivities of the bacteria. Tetracyclines, fluoroquinolones and sulfamethoxazole and trimethoprim as well as Geocillin ( off the U.S. market) are the antibiotics that get the best tissue levels in the non-acutely infected prostate. Hopefully your bacterial strain is sensitive to one of these. If not, then I'd want to put you on a long course of an appropriate antibiotic that produced some tissue levels (not nitrofurantoin).
I am unaware of non-antibiotic thereapies for treating such an infection. I would make it a point to have multiple ejaculations in the midst of treatment to get rid of infected semen.
S.A.Liroff, M.D.
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