Fosfomycin for the treatment of patients with bacterial prostatitis: a systematic review

Bacterial prostatitis is a common infection affecting the patient's quality of life. It is caused by various bacteria, including multidrug-resistant Enterobacterales. Fosfomycin is active against most implicated pathogens, has good penetration in the prostate, and thus, has been used in patients with bacterial prostatitis.

A systematic review of studies assessing the effectiveness of fosfomycin in adult patients with bacterial prostatitis. The primary outcome was clinical cure and secondary outcomes were microbiological cure, re-occurrence, and adverse events.

Four cohort studies and 1 phase I-II trial were identified, including 117 patients with chronic and acute bacterial prostatitis. In 4 studies with chronic bacterial prostatitis, 72/99 (73%), 77/99 (78%), and 15/99 (15%) of patients had clinical cure, microbiological cure, and adverse events, respectively. In 1 study with acute bacterial prostatitis, 18/18 (100%), 11/12 (92%), and 2/18 (11%) of patients had clinical cure, microbiological cure, and adverse events, respectively. Also, 12 case reports were identified. In 5 cases with chronic bacterial prostatitis, 2/5 had both clinical and microbiological cures, and 1/5 had mild adverse events. In 8 patients with acute bacterial prostatitis, 8/8, 6/8, and 2/8 had clinical cure, microbiological cure, and adverse events, respectively.

Fosfomycin could be valuable in the treatment of patients with bacterial prostatitis when there are no other antibiotic options. Due to the limited available published clinical data, a more rigorous evaluation of its effectiveness and safety in this population is needed.