Fosfomycin for Treatment of Prostatitis: New Tricks for Old Dogs: Figure 1.

Grayson, M. Lindsay; Macesic, Nenad; Trevillyan, Janine M; Ellis, Andrew G.; Zeglinski, Phillip T.; Hewitt, N.; Gardiner, Bradley J.; Frauman, Albert G

doi:10.1093/cid/civ436

Cited by 50 publications

(59 citation statements)

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“…Since fosfomycin prostate levels are around 4 g/g of tissue, and some isolates may have had MICs of Ͼ4 g/ml, this may be the reason for some failures. We concur with other authors (12,17,18) who suggest that fosfomycin should not be used for treating CBP caused by microorganisms with MICs of Ն4 g/ml. Another factor to consider is that fosfomycin activity is higher in an acidic environment, but the pH is alkaline in CBP (around 8.5), which might lead to decreased activity of the drug (18).…”

supporting

confidence: 90%

“…This value is higher than the MIC breakpoint of many uropathogens. In addition, FT proved useful in 2 cases of multidrug-resistant Enterobacteriaceae (MDRE) prostatitis (12 In this retrospective study, we assessed the efficacy of FT as an alternative therapy for patients with difficult-to-treat CBP. The inclusion criteria were a diagnosis of CBP, failure of prolonged antibiotic therapy, and no possibility of fluoroquinolone or cotrimoxazole use due to resistance, failure, or side effects (Fig.…”

mentioning

confidence: 99%

“…This value is higher than the MIC breakpoint of many uropathogens. In addition, FT proved useful in 2 cases of multidrug-resistant Enterobacteriaceae (MDRE) prostatitis (12).…”

mentioning

confidence: 99%

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Long-Term Fosfomycin-Tromethamine Oral Therapy for Difficult-To-Treat Chronic Bacterial Prostatitis

Los‐Arcos

Pigrau

Rodríguez-Pardo

et al. 2016

Antimicrob Agents Chemother

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This is a retrospective study of 15 difficult-to-treat (i.e., exhibiting previous failure, patient side effects, or resistance to ciprofloxacin and co-trimoxazole) chronic bacterial prostatitis infections (5 patients with multidrug-resistant Enterobacteriaceae [MDRE]) receiving fosfomycin-tromethamine at a dose of 3 g per 48 to 72 h for 6 weeks. After a median follow-up of 20 months, 7 patients (47%) had a clinical response, and 8 patients (53%) had persistent microbiological eradication; 4/5 patients with MDRE isolates achieved eradication. There were no side effects. Fosfomycin-tromethamine is a possible alternative therapy for chronic bacterial prostatitis. Chronic bacterial prostatitis (CBP) is a troublesome disease, showing an overall clinical and microbiological response rate to fluoroquinolones, the antibiotics of choice, of only 60% (1-4). In CBP caused by Escherichia coli, the reported resistance rates are 11% to ciprofloxacin and 20% to norfloxacin (5). Co-trimoxazole is an alternative antibiotic option, but its cure rates are lower than those of other drugs (1, 4). The resistance rate to co-trimoxazole is high in patients with urinary tract infections (UTI) (around 34% in Spain) (6), and reported resistance in E. coli CBP is 24% (5). Other antibiotics are usually ineffective due to poor prostatic penetration; hence, there may be no effective antibiotic therapy for some patients (1).Fosfomycin-tromethamine (FT) has broad-spectrum antimicrobial activity and is useful for treating lower UTI caused by extended-spectrum ␤-lactamase (ESBL)-producing Enterobacteriaceae (7-10). Mean fosfomycin levels in the uninflamed peripheral prostate region after 3 g of FT were found to be Ͼ4 g/g of tissue in 70% of patients (11). This value is higher than the MIC breakpoint of many uropathogens. In addition, FT proved useful in 2 cases of multidrug-resistant Enterobacteriaceae (MDRE) prostatitis (12 In this retrospective study, we assessed the efficacy of FT as an alternative therapy for patients with difficult-to-treat CBP. The inclusion criteria were a diagnosis of CBP, failure of prolonged antibiotic therapy, and no possibility of fluoroquinolone or cotrimoxazole use due to resistance, failure, or side effects (Fig. 1). All patients had been treated and followed up in our UTI outpatient clinic (January 2010 to July 2014) by one of the authors (C.P.). The study was approved by the hospital ethics committee and Spanish Drug Agency (approval VDH-FOS-2014-01).A diagnosis of CBP was established when all 4 criteria were met: (i) history of CBP, defined as Ն1 previous symptomatic episode of bacterial prostatitis of Ն4 weeks duration or Ն2 episodes of any duration in the preceding 12 months; (ii) current symptoms of prostatitis; (iii) absence of genitourinary abnormalities on Ն1 urologic ultrasound assessment; and (iv) current laboratory evidence of infection, including positive Meares-Stamey test result (14), positive semen culture, or Ն2 positive urine cultures with the same microorganism performed Ն1 month apart, in which ...

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confidence: 99%

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Long-Term Fosfomycin-Tromethamine Oral Therapy for Difficult-To-Treat Chronic Bacterial Prostatitis

Los‐Arcos

Pigrau

Rodríguez-Pardo

et al. 2016

Antimicrob Agents Chemother

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“…More robust data from well-designed and adequately powered studies should become available in order to reach safer conclusions. Finally, few case reports support fosfomycin use, alone or in combination with other antibiotics, for the treatment of patients with acute prostatitis (233)(234)(235).…”

Section: Urinary Tract Infectionsmentioning

confidence: 99%

Fosfomycin

et al. 2016

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SUMMARYThe treatment of bacterial infections suffers from two major problems: spread of multidrug-resistant (MDR) or extensively drug-resistant (XDR) pathogens and lack of development of new antibiotics active against such MDR and XDR bacteria. As a result, physicians have turned to older antibiotics, such as polymyxins, tetracyclines, and aminoglycosides. Lately, due to development of resistance to these agents, fosfomycin has gained attention, as it has remained active against both Gram-positive and Gram-negative MDR and XDR bacteria. New data of higher quality have become available, and several issues were clarified further. In this review, we summarize the available fosfomycin data regarding pharmacokinetic and pharmacodynamic properties, thein vitroactivity against susceptible and antibiotic-resistant bacteria, mechanisms of resistance and development of resistance during treatment, synergy and antagonism with other antibiotics, clinical effectiveness, and adverse events. Issues that need to be studied further are also discussed.

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“…For the treatment of UTIs, nitrofurantoin administration was replaced with fosfomycin, which has been proposed to have a potential role in prophylaxis or treatment of prostatitis without any report of toxicity issues regarding its use [16] [17].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Fibrosis Due to Nitrofurantoin Therapy: A Case Report

Grigorakos¹,

Poulakou²,

Lazarescu³

et al. 2017

OJRD

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We report the case of a patient with pulmonary fibrosis, developed as an adverse reaction to nitrofurantoin therapy received for totally 6 months for the prevention of recurrent urinary tract infections. Chest X-ray and CT scan revealed extensive elements of interstitial pulmonary fibrosis. After diagnosis, administration of nitrofurantoin was immediately stopped; and specific prolonged therapy with low-dose corticosteroids per os and inhaled steroids were administered. The patient responded successfully both clinically and biochemically and possible digestive system side effects were prevented through the administration of gastroprotection medication. For the prevention of urinary tract infection, the patient received well tolerated therapy with fosfomycin which was further continued as a prophylactic agent.

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Fosfomycin for Treatment of Prostatitis: New Tricks for Old Dogs: Figure 1.

Abstract: Treatment options for prostatitis caused by multidrug-resistant gram-negative bacilli are limited. We report two cases cured with oral fosfomycin and provide a pharmacokinetic analysis of fosfomycin predose concentrations during treatment.

Cited by 50 publications

References 13 publications

Long-Term Fosfomycin-Tromethamine Oral Therapy for Difficult-To-Treat Chronic Bacterial Prostatitis

Long-Term Fosfomycin-Tromethamine Oral Therapy for Difficult-To-Treat Chronic Bacterial Prostatitis

Fosfomycin

Pulmonary Fibrosis Due to Nitrofurantoin Therapy: A Case Report

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