Is fosfomycin a potential treatment alternative for multidrug-resistant gram-negative prostatitis?

Area of Science:

• Pharmacokinetics and Drug Penetration
• Infectious Diseases
• Urology

Background:

• Multidrug-resistant gram-negative bacterial (MDR-GNB) infections pose a growing threat, particularly complicating prostate biopsies.
• Fluoroquinolone resistance limits treatment options for MDR-GNB prostatitis.
• Fosfomycin's effectiveness in prostate infections is uncertain due to unknown penetration.

Purpose of the Study:

• To evaluate the penetration of fosfomycin into prostate tissue.
• To determine if a single oral dose of fosfomycin achieves therapeutic concentrations in the prostate.
• To assess fosfomycin concentrations in serum, urine, and prostate tissue.

Main Methods:

• Prospective study in men undergoing prostate surgery for benign prostatic hyperplasia.
• Single 3-g oral dose of fosfomycin administered.
• Serum, urine, and prostate tissue (transition zone and peripheral zone) concentrations measured via liquid chromatography-tandem mass spectrometry.

Main Results:

• Mean prostate fosfomycin levels reached 6.5 ± 4.9 µg/g, with detectable concentrations up to 17 hours post-dose.
• Therapeutic concentrations (≥4 µg/g) were achieved in 70% of participants.
• Prostate tissue concentrations were higher in the transition zone (8.3 µg/g) than the peripheral zone (4.4 µg/g).

Conclusions:

• Fosfomycin achieves reasonable intraprostatic concentrations after a single oral dose.
• It may serve as a prophylactic agent for transrectal ultrasound (TRUS)-guided prostate biopsy.
• Fosfomycin could be a potential treatment for multidrug-resistant gram-negative bacterial prostatitis, warranting clinical trials.