Oral Fosfomycin for the Treatment of Acute and Chronic Bacterial Prostatitis Caused by Multidrug-Resistant Escherichia coli

Abstract

Acute and chronic bacterial prostatitis in outpatients is commonly treated with oral fluoroquinolones; however, the worldwide dissemination of multidrug-resistant (MDR) Escherichia coli has resulted in therapeutic failures with fluoroquinolones. We reviewed the literature regarding the use of oral fosfomycin in the treatment of acute and chronic prostatitis caused by MDR E. coli. All English-language references on PubMed from 1986 to June 2017, inclusive, were reviewed from the search “fosfomycin prostatitis.” Fosfomycin demonstrates potent in vitro activity against a variety of antimicrobial-resistant E. coli genotypes/phenotypes including ciprofloxacin-resistant, trimethoprim-sulfamethoxazole-resistant, extended-spectrum β-lactamase- (ESBL-) producing, and MDR isolates. Fosfomycin attains therapeutic concentrations (≥4 μg/g) in uninflamed prostatic tissue and maintains a high prostate/plasma ratio up to 17 hours after oral administration. Oral fosfomycin's clinical cure rates in the treatment of bacterial prostatitis caused by antimicrobial-resistant E. coli ranged from 50 to 77% with microbiological eradication rates of >50%. An oral regimen of fosfomycin tromethamine of 3 g·q 24 h for one week followed by 3 g·q 48 h for a total treatment duration of 6–12 weeks appeared to be effective. Oral fosfomycin may represent an efficacious and safe treatment for acute and chronic prostatitis caused by MDR E. coli.

Genomic analysis and immune response in a murine mastitis model of vB_EcoM-UFV13, a potential biocontrol agent for use in dairy cows

“…E. coli 30, an isolate obtained from a dairy cow with acute mastitis, displays resistance to 14 of 25 evaluated antibiotics (Supplementary Table 5 ). This bacterium is resistant to at least three different antimicrobial drug classes, which allows its classification as a multi-drug resistant strain 66 Moreover, of the four types of virulence factors analyzed (biofilm forming capability and motility types: swarming, swimming and twitching) the E. coli 30 was positive for biofilm formation, swarming, and swimming, being negative only for the twitching (Supplementary Table 6 ). Studies correlated this virulence factors to an increase in pathogenicity and immune response evasion 67 , 68 .…”

Receptor pharmacology and other relevant factors in lower urinary tract pathology under a functional and toxicological approach: Instrument to better manage antimicrobials therapy

“…Oral regimen of fosfomycin tromethamine of 3 g•q 24 h for one week followed by 3 g•q 48 h for a total treatment duration of 6-12 weeks appeared to be effective. The Oral fosfomycin may represent an ef icacious and safe treatment for acute and chronic prostatitis caused by MDR E. coli " [40].…”

Pharmacological Interventions for Bacterial Prostatitis

“…Fluoroquinolone resistance among clinical isolates of E. coli has been reported since 2002. A steep increase in urinary and prostatic infections due to MDR gram-negative Enterobacteriaceae globally, even in the community, and the prevalence of ESBL-producing bacteria render invalidity to fluoroquinolones and affect the choice of treatment options (de la Rosette et al, 1993;Zowawi et al, 2015;Zhanel et al, 2018). Fluoroquinolones resistance in urinary E. coli is reportedly as high as 70%, and approximately 60% of strains produce ESBLs simultaneously in many Asian countries, including China, India, and Vietnam (Zowawi et al, 2015).…”