Fosfomycin Trometamol (3,000 mg) in Perioperative Antibiotic Prophylaxis of Healthcare-Associated Infections after Endourological Interventions: A Narrative Review

Abstract

Introduction: Increasing antibiotic resistance also has an impact on perioperative antibiotic prophylaxis (PAP). This narrative review evaluates fosfomycin trometamol (FT) as PAP in endourological interventions. Materials and Methods: Nine clinical studies including 4 randomized comparative studies were analyzed. A total of 1,614 patients received FT as PAP for different endourological procedures and extracorporeal shock wave lithotripsy [ESWL; i.e. cystoscopy (n = 498), urodynamic studies (n = 39), ureteropyeloscopy (n = 10), urethrotomy (n = 20), lithotripsy (n = 15), transurethral resection of bladder tumors (n = 139), transurethral resection of the prostate (n = 843), ESWL (n = 20), ureterorenoendoscopic lithotripsy (n = 18), percutaneous nephrostomic lithotripsy (n = 12)]. Results: In 8 clinical studies, FT was shown to be effective in preventing healthcare-associated urinary tract infections (HAUTIs). One study showed no benefit. The usual dosage regimen was oral administration of 3 g of FT 3 h before and 24 h after the procedure. In 1 randomized comparative study investigating HAUTIs after diagnostic cystoscopy, it could also be shown that a single oral dose of 3 g of FT 3 h before cystoscopy was as effective as a double dose. Conclusion: According to the published results, for traumatic endourological interventions and surgical procedures, an oral dosage of 3 g of FT 3 h before and 24 h after the procedure and only 1 (prior) oral dosage for diagnostic procedures might be an alternative if PAP is indicated. Limitations of the studies are the low numbers of patients included for most indications.

Antimicrobial prophylaxis for transrectal ultrasound-guided prostate biopsy: fosfomycin trometamol, an attractive alternative

“…Recently, Wagenlehner et al [3] reported that fluoroquinolones were used in 98.2 % of patients, but resistance against fluoroquinolones was seen in 60 % of all bacterial strains isolated after the procedure. An alternative strategy to the fluoroquinolone-based prophylaxis is therefore needed [9,27]. Here, we performed a retrospective cohort analysis in patients who underwent TR-PB and demonstrated that FT may be an attractive alternative antimicrobial prophylaxis for TR-PB due to a lower rate of symptomatic UTIs and a lower rate of adverse events as compared with CIP.…”

“…Thus, infectious complications after TR-PB represent an important challenge for the urologist and for patients. On the other hand, several authors reported that fosfomycin trometamol (FT) could be a valid alternative for antibiotic prophylaxis of TR-PB due to its low profile of resistance, elevated activity against multidrug-resistant (MDR) Gram-negative bacteria and favorable pharmacokinetic properties [8][9][10]. Here, we aimed to compare the clinical outcome of patients who underwent TR-PB and received prophylaxis with either FT or ciprofloxacin (CIP), by means of a retrospective, comparative cohort study.…”

Fosfomycin

“…In a recently published review regarding the effectiveness of fosfomycin in preventing UTI after endourological interventions or surgical procedures, the authors concluded that one or two doses of fosfomycin trometamol could be an effective alternative. The conclusion was limited by the small number of available patients for every indication (253). In an RCT not included in that review, fosfomycin (3 g by mouth every 48 h for two doses) was compared with ciprofloxacin (500 mg by mouth every 12 h for 5 days) for prevention of prostatitis after transrectal prostate biopsy; 671 patients were enrolled.…”

Should We Use Antibiotic Prophylaxis for Flexible Cystoscopy? A Systematic Review and Meta-Analysis

“…Herr's study was on the frequency of UTIs in patients with bladder cancer and after BCG treatment [21]. Alsaywid et al and Wagenlehner et al, produced review articles [22,23], while Hori and Kennedy's article is a commentary on one of the included studies [24]. …”