From the Guidelines
Fosfomycin oral can be used to treat uncomplicated cystitis in men, though it is not typically first-line therapy, with a recommended dosage of 3 grams of fosfomycin tromethamine powder (Monurol) dissolved in water as a single dose, and potentially a second dose 24-48 hours later for better efficacy, as supported by the most recent guidelines from the American College of Physicians 1. The use of fosfomycin in treating uncomplicated cystitis in men is based on its efficacy against common urinary pathogens, including E. coli and Enterococcus, and its ability to maintain high urinary concentrations for 24-48 hours after dosing. However, it is essential to note that fosfomycin may have inferior efficacy compared to other available therapies, such as nitrofurantoin or trimethoprim-sulfamethoxazole, as reported in the 2011 guidelines from the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases 1. Some key points to consider when using fosfomycin to treat uncomplicated cystitis in men include:
- Obtaining a urine culture to confirm the diagnosis and susceptibility before starting treatment
- Using fosfomycin as a single dose, with the potential for a second dose 24-48 hours later for better efficacy
- Being aware of the potential for inferior efficacy compared to other available therapies
- Considering alternative treatments, such as fluoroquinolones or trimethoprim-sulfamethoxazole, for men with complicated UTIs, pyelonephritis, prostatitis, or recurrent infections. It is also important to note that the guidelines from the American College of Physicians 1 recommend short-course antibiotics for uncomplicated cystitis and pyelonephritis, with fosfomycin being one of the options for women with uncomplicated bacterial cystitis. However, the guidelines do not specifically address the use of fosfomycin in men with uncomplicated cystitis. Therefore, the recommendation to use fosfomycin in men is based on the available evidence and clinical expertise, with the goal of minimizing morbidity, mortality, and improving quality of life.
From the Research
Efficacy of Fosfomycin in Treating Cystitis in Males
- The efficacy of fosfomycin tromethamine in treating cystitis in males is not directly addressed in the provided studies, as most of the studies focus on its use in women or do not specify the gender of the patients 2, 3, 4.
- However, one study mentions that fosfomycin tromethamine is used off-label for complicated UTIs and prostatitis in men, suggesting that it may be effective in treating cystitis in males 5.
- Another study discusses the use of oral fosfomycin in treating complicated lower urinary tract infections, including in patients with multidrug-resistant pathogens, but does not specify the gender of the patients 6.
Treatment Outcomes
- A study on solid organ transplant recipients with renal dysfunction found that fosfomycin tromethamine was successful in treating cystitis, with no significant difference in treatment success between patients with renal dysfunction and those with normal renal function 5.
- A review of the literature on oral fosfomycin for complicated urinary tract infections found that it was effective in treating patients who had previously failed treatment with another agent, were infected with a multidrug-resistant pathogen, or could not tolerate first-line treatment 6.