Can fosfomycin be used to treat prostatitis?

From the Guidelines

Fosfomycin is not a recommended treatment option for prostatitis due to its limited effectiveness in achieving adequate concentrations in prostatic tissue. The most recent guidelines for the prevention, diagnosis, and management of urinary tract infections, including prostatitis, do not provide a clear recommendation for the use of fosfomycin in treating prostatitis 1. According to these guidelines, there is a dearth of data on the treatment of both acute and chronic bacterial prostatitis, and historical durations of treatment range from 14 days for acute bacterial prostatitis to 6 weeks or longer for chronic bacterial prostatitis.

Some key points to consider when treating prostatitis include:

• The lack of clear recommendations for the duration of treatment for both acute and chronic bacterial prostatitis 1
• The need for alternative treatment options, such as fluoroquinolones or trimethoprim-sulfamethoxazole, which are preferred for acute and chronic bacterial prostatitis
• The potential for fosfomycin to be considered in cases where the causative organism is resistant to standard therapies and susceptible to fosfomycin, but this would be an off-label use and should be guided by culture results and specialist advice

It is essential to prioritize the use of evidence-based treatments for prostatitis, and fosfomycin is not a first-line treatment option due to its limited effectiveness in achieving adequate concentrations in prostatic tissue. Instead, treatments like fluoroquinolones or trimethoprim-sulfamethoxazole are preferred, and the duration of treatment should be guided by the severity of the infection and the patient's response to therapy.

From the FDA Drug Label

Fosfomycin is distributed to the kidneys, bladder wall, prostate, and seminal vesicles Fosfomycin has been shown to cross the placental barrier in animals and man Fosfomycin (the active component of fosfomycin tromethamine) has in vitro activity against a broad range of gram-positive and gram-negative aerobic microorganisms which are associated with uncomplicated urinary tract infections

Fosfomycin can be used to treat prostatitis because it is distributed to the prostate and has in vitro activity against a broad range of microorganisms associated with urinary tract infections 2.

From the Research

Fosfomycin for Prostatitis Treatment

• Fosfomycin has been studied as a potential treatment for bacterial prostatitis, including acute and chronic forms, due to its ability to achieve adequate prostatic concentrations and its activity against resistant micro-organisms 3.
• The evidence suggests that fosfomycin is effective in treating chronic bacterial prostatitis caused by Escherichia coli, with clinical cure rates ranging from 50 to 77% and microbiological eradication rates of >50% 4.
• Fosfomycin has also been shown to be effective in treating acute bacterial prostatitis caused by multidrug-resistant Enterobacterales, with a clinical cure rate of 100% and a microbiological cure rate of 92% in one study 5.
• The use of fosfomycin for prostatitis treatment is supported by its favorable pharmacokinetic profile, safety profile, and low resistance rate 6.
• Oral fosfomycin regimens, such as 3g every 24 hours for 1 week followed by 3g every 48 hours for a total treatment duration of 6-12 weeks, have been used effectively in clinical studies 4, 7.

Efficacy and Safety

• The efficacy of fosfomycin in treating prostatitis has been demonstrated in several studies, with cure rates ranging from 80 to 100% 4, 5, 7.
• The safety profile of fosfomycin is generally favorable, with the most common adverse event being diarrhea, reported in 18% of patients in one study 7.
• Fosfomycin has been shown to be effective against multidrug-resistant bacteria, including ESBL-producing and carbapenemase-producing strains 4, 5.

Clinical Implications

• Fosfomycin may represent a valid therapeutic option for the treatment of acute and chronic bacterial prostatitis, particularly in cases of treatment failure, intolerance to first-line therapy, or multidrug-resistant organisms 3, 6.
• Further studies, including randomized controlled trials, are needed to firmly establish the optimal dosing regimen, efficacy, and place in therapy of fosfomycin for prostatitis treatment 3, 6.