What is the role of fosfomycin in the treatment of chronic bacterial prostatitis (CBP)?

Updated: Jan 15, 2019
  • Author: Samantha D Kraemer, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Fosfomycin achieves reasonable tissues levels in the prostate and should be considered in patients with multidrug-resistant gram-negative bacteria on cultures. Fosfomycin is more active in an acidic environment, so the alkaline pH seen during CBP may decrease its activity.

Case reports have documented successful use of fosfomycin for treatment of prostatitis caused by multidrug-resistant gram-negative bacilli. [43, 71] A single case report describes successful use of the combination of fosfomycin and doxycycline to treat persistent prostatitis from ESBL-positive Escherichia coli that was refractory to prolonged courses of fosfomycin alone. [44]

Los-Arcos et al reported on the use of fosfomycin-tromethamine in 15 patients with CBP (five with multi-drug–resistant Enterobacteriaceae [MDRE] infection) that had proved difficult to treat because of adverse effects or resistance to ciprofloxacin and cotrimoxazole. The patients received 3 g every 48-72 h for 6 weeks. After a median follow-up of 20 months, seven of the patients (47%) had clinical responses and eight (53%) had persistent microbiological eradication; four of the five patients with MDRE isolates achieved eradication. None of the patients experienced adverse effects. [45]


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