Fosfomycin for bacterial prostatitis: a review.

Area of Science:

• Pharmacology
• Infectious Diseases
• Urology

Background:

• Growing interest in fosfomycin for bacterial prostatitis due to adequate prostatic concentrations, activity against resistant microbes, and low toxicity.
• Increasing antimicrobial resistance necessitates exploring alternative treatment options for prostatitis.

Purpose of the Study:

• To review current clinical evidence for fosfomycin in treating acute and chronic bacterial prostatitis.
• To evaluate fosfomycin's role in managing prostatitis in the context of rising antimicrobial resistance.

Main Methods:

• Systematic literature search of PubMed, Scopus, EMBASE, Web of Science, Google Scholar, and ClinicalTrials.gov (January 1984 - November 2019).
• Inclusion of observational studies reporting fosfomycin use (more than one dose) for bacterial prostatitis.
• Analysis of ten identified observational studies meeting inclusion criteria.

Main Results:

• Limited evidence for acute bacterial prostatitis; most data pertains to chronic prostatitis caused by Escherichia coli.
• Extended fosfomycin courses demonstrated safety and efficacy in achieving clinical and microbiological cure.
• Fosfomycin was primarily used for treatment failures, intolerance to first-line agents, or multi-resistant organisms.

Conclusions:

• Fosfomycin is a potential first-line alternative for acute and chronic bacterial prostatitis due to its safety and efficacy profile.
• Further randomized controlled trials are needed to establish optimal dosing, efficacy, and therapeutic positioning.
• Fosfomycin's role may expand given the challenges posed by resistant organisms and adverse effects of other treatments.