Oral prophylaxis with fosfomycin trometamol in transurethral prostatectomy and urological maneuvers: Literature review and personal experience

Abstract

In the literature there are three comparative and two open studies in which 1,395 patients received 3 g of fosfomycin trometamol per os 12 or three hours before and 24 hours after surgery: 625 patients received control substances or placebo. In the comparative studies the incidence of postoperative bacteriuria in patients treated with fosfomycin trometamol ranged from 2.9 to 7.6% at one week and from 1.2 to 3.2% at two to four weeks follow-up, and was lower than in patients treated with reference drugs or placebo. In the open study, postoperative bacteriuria ranged from 2.9 to 6.0% at one week follow-up. In our open study, 70 patients were evaluable. Four out of 70 (5.7%) developed fever > or = 38 degrees C, with positive urine culture, during the first three postoperative days. At two weeks follow-up another 5.7% showed a symptomatic urinary tract infection with a cumulative infection rate of 11.4%. In all cases, the bacteria were resistant to fosfomycin trometamol. A low incidence, 4.2%, of side effects, mainly related to the gastrointestinal tract, was observed. Fosfomycin trometamol proved to be effective with the advantage of no risk of cross resistance, practical pharmaceutical formulation with good patient compliance, good safety profile with few side effects and a satisfactory cost/benefit ratio.

Efficacy of a Novel Prophylactic Scheme of Fosfomycin Trometamol in Patients Undergoing Endoscopic Surgery for Benign Prostatic Hyperplasia: Findings from a Prospective Monocentric Single-Arm Study

“…Our findings are consistent with those of other studies carried out among urologic patients undergoing TURP receiving different dosing schemes of fosfomycin trometamol, either as prophylaxis or as mixed prophylaxis/preemptive [14,[28][29][30][31][32][33][34]. In a prospective, randomized, placebo controlled, double-blind study carried out among patients undergoing TURP, two doses of fosfomycin trometamol or of placebo 24 h apart were administered, one in the evening before and the other in the evening after the intervention [28].…”

The Effectiveness of Single-Dose Fosfomycin as Antimicrobial Prophylaxis for Patients Undergoing Transrectal Ultrasound-Guided Biopsy of the Prostate

“…Peak urinary concentrations occur within 4 h of dosing, and urinary levels of fosfomycin remain high for a prolonged period (over 24 h); thus, these levels are sufficient to inhibit most urinary pathogens [25] . We performed all the TRUSBG in the morning and finished by 12.00 p.m., so the patients received fosfomycin prophylaxis the night before the procedure [25,26] . According to our knowledge, this article is the first in the literature on the use of fosfomycin for prophylaxis in TRUSBP.…”

Clinical significance of the pharmacokinetic and pharmacodynamic characteristics of fosfomycin for the treatment of patients with systemic infections

“…Oral fosfomycin tromethamine has also been evaluated as chemoprophylaxis for transurethral prostatectomy [53]. In this respect, administration of 3 g of fosfomycin tromethamine both before and after the procedure appears to be effective and safe in reducing post-operative bacteriuria.…”