Long-Term Fosfomycin-Tromethamine Oral Therapy for Difficult-To-Treat Chronic Bacterial Prostatitis

Abstract

This is a retrospective study of 15 difficult-to-treat (i.e., exhibiting previous failure, patient side effects, or resistance to ciprofloxacin and co-trimoxazole) chronic bacterial prostatitis infections (5 patients with multidrug-resistant Enterobacteriaceae [MDRE]) receiving fosfomycin-tromethamine at a dose of 3 g per 48 to 72 h for 6 weeks. After a median follow-up of 20 months, 7 patients (47%) had a clinical response, and 8 patients (53%) had persistent microbiological eradication; 4/5 patients with MDRE isolates achieved eradication. There were no side effects. Fosfomycin-tromethamine is a possible alternative therapy for chronic bacterial prostatitis. Chronic bacterial prostatitis (CBP) is a troublesome disease, showing an overall clinical and microbiological response rate to fluoroquinolones, the antibiotics of choice, of only 60% (1-4). In CBP caused by Escherichia coli, the reported resistance rates are 11% to ciprofloxacin and 20% to norfloxacin (5). Co-trimoxazole is an alternative antibiotic option, but its cure rates are lower than those of other drugs (1, 4). The resistance rate to co-trimoxazole is high in patients with urinary tract infections (UTI) (around 34% in Spain) (6), and reported resistance in E. coli CBP is 24% (5). Other antibiotics are usually ineffective due to poor prostatic penetration; hence, there may be no effective antibiotic therapy for some patients (1).Fosfomycin-tromethamine (FT) has broad-spectrum antimicrobial activity and is useful for treating lower UTI caused by extended-spectrum ␤-lactamase (ESBL)-producing Enterobacteriaceae (7-10). Mean fosfomycin levels in the uninflamed peripheral prostate region after 3 g of FT were found to be Ͼ4 g/g of tissue in 70% of patients (11). This value is higher than the MIC breakpoint of many uropathogens. In addition, FT proved useful in 2 cases of multidrug-resistant Enterobacteriaceae (MDRE) prostatitis (12 In this retrospective study, we assessed the efficacy of FT as an alternative therapy for patients with difficult-to-treat CBP. The inclusion criteria were a diagnosis of CBP, failure of prolonged antibiotic therapy, and no possibility of fluoroquinolone or cotrimoxazole use due to resistance, failure, or side effects (Fig. 1). All patients had been treated and followed up in our UTI outpatient clinic (January 2010 to July 2014) by one of the authors (C.P.). The study was approved by the hospital ethics committee and Spanish Drug Agency (approval VDH-FOS-2014-01).A diagnosis of CBP was established when all 4 criteria were met: (i) history of CBP, defined as Ն1 previous symptomatic episode of bacterial prostatitis of Ն4 weeks duration or Ն2 episodes of any duration in the preceding 12 months; (ii) current symptoms of prostatitis; (iii) absence of genitourinary abnormalities on Ն1 urologic ultrasound assessment; and (iv) current laboratory evidence of infection, including positive Meares-Stamey test result (14), positive semen culture, or Ն2 positive urine cultures with the same microorganism performed Ն1 month apart, in which ...

Potential Use of Fosfomycin-Tromethamine for Treatment of Recurrent Campylobacter Species Enteritis

“…Although prolonged oral FT therapy has not been used extensively, we have some experience with the drug in patients with chronic bacterial prostatitis. Oral FT at 3 g every 48 to 72 h for 6 weeks proved to be safe and well tolerated (16).…”

“…Fosfomycin-tromethamine is an old drug that has been recently rediscovered for the treatment of multidrug-resistant infections and other difficult-to-treat infections (15,16). It diffuses and distributes well into tissues and is excreted unchanged in urine (38%) and feces (18%) (15), characteristics that are potentially useful for eradicating intracellular and luminal reservoirs of Campylobacter.…”

Pharmacodynamic Evaluation of Fosfomycin against Escherichia coli and Klebsiella spp. from Urinary Tract Infections and the Influence of pH on Fosfomycin Activities

“…However, for more complicated UTI cases (for which fosfomycin is not approved), multiple doses have been used. In parts of the world, including Brazil, where intravenous fosfomycin is not available, interest in regimens with multiple doses of oral fosfomycin for treating complicated UTIs and related infections has been renewed (3,4).…”

Fosfomycin: what was old is new again

“…The patients received 3 g oral fosfomycin every 48–72 h for 6 weeks. After a median follow up of 20 months, seven patients (47%) had a clinical response . Fosfomycin may also prove to be a useful alternative in the prevention of trans‐rectal ultrasound‐guided prostate biopsy‐related infectious complications in patients with a high risk of quinolone resistance …”