Fosfomycin for Chronic Bacterial Prostatitis
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Prostatitis is the inflammation and infection of the
prostate. The bacterial pathogens involved are similar to those involved in
other urologic infections. Although Escherichia coli is
the most common causative pathogen, other etiologies include Pseudomonas aeruginosa, Klebsiella spp.,
Enterococcus spp., Enterobacter spp., Proteus spp., and Serratia spp. In sexually active
men, Neisseria gonorrhoeae and Chlamydia trachomatis should also
be considered.1 Treatment of prostatitis can be difficult, as many
antimicrobials cannot penetrate into the prostate. Current oral treatment
options include fluoroquinolones, tetracyclines, and sulfamethoxazole/trimethoprim.
However, adverse reactions and increasing resistance against these
antimicrobials warrant alternative options for oral therapy.
Fosfomycin is an attractive potential option because it does not cross-react
with other antimicrobials, making it a good choice in patients with extensive
drug allergies. It retains activity against many of the implicated organisms,
including multidrug-resistant strains such as extended-spectrum beta-lactamase
(ESBL)-producing Enterobacteriales and
vancomycin-resistant enterococci. It is also available in an oral dosage form.
However, aside from a few case reports, there are limited data regarding the
dosing, duration, and efficacy of fosfomycin for the treatment of prostatitis.2,3
Karaiskos and colleagues conducted a prospective observation study that set out
to identify the effectiveness and safety of oral fosfomycin in the treatment of
chronic prostatitis.⁴ Patients were enrolled if they had more than 3 months of
symptoms consistent with prostatitis, positive urine/prostatic secretion
cultures, a negative polymerase chain reaction for sexually transmitted
infections, imaging suggesting prostatic inflammation and did not have other
orally available antimicrobial options (eg, were resistant, had allergies or
adverse reactions). Patients provided consent to participate. Fosfomycin was
dosed at 3 g orally daily for 1 week, then 3 g orally every 48 hours for the
remainder of therapy. Patients were treated for either 6 weeks or 12 weeks, if
they had evidence of prostatic calcifications. Minimum inhibitory concentrations
(MICs) were evaluated via Etest (bioMérieux). Primary outcomes included cure at
end of therapy, defined as resolution or improvement of all signs of
infection, and relapse rates, defined as isolation of the same causative
pathogen during treatment or follow-up, at 3 and 6 months of follow-up.
Forty-four male patients were enrolled, ranging in age from 28 to 82 years
(median 54). Most patients had experienced 2 episodes of chronic bacterial
prostatitis. E coli was the most common
causative pathogen (66%), followed by Klebsiella (14%),
and Enterococcus faecalis (14%). Most
isolates were multidrug-resistant (59%), with 23% displaying evidence of ESBL.
The median fosfomycin MIC was 1.5 mcg/ mL (range, 0.125-32 mcg/ mL) for
gram-negatives and 8 mcg/mL (range 4-24 mcg/ mL) for E faecalis.
Cure was achieved in 82% (36/44 patients) of participants at end of therapy,
with a similar breakdown between the 6- and 12-week groups (Table).
Cure at the 3- and 6-month follow-ups were 80% and 73%, respectively. Fosfomycin
resistance emerged in 5 patients, 2 were in the 6-week group and 3 in the
12-week group. Overall, fosfomycin was well tolerated. Eight patients (18%)
reported diarrhea, which resolved in 4 patients by extending the dosing
interval from every 48 hours to every 72 hours. One patient discontinued
treatment due to diarrhea. No patients tested positive for Clostridioides difficile.
0 likes, 10 replies
derek76
Posted
Continuation of report.
Although this was a small, single-center study with no comparator arm, the results provide valuable insight into the treatment of chronic bacterial prostatitis. This is the largest study to date of oral fosfomycin for this condition, with positive results. A more concrete dosing regimen was used, and the study provided long-term tolerability information. Additionally, a significant number of patients presented with resistant organisms.
In an era of increasing antimicrobial resistance, the only option for many patients may be intravenous therapy. Furthermore, many patients may not tolerate the available oral options that can penetrate the prostate. The fluoroquinolones, which have long been considered the gold standard of prostatitis treatment, carry several concerning adverse effects. Additionally, fluoroquinolones, sulfamethoxazole/trimethoprim, and tetracyclines can interact with many other medications.
This study’s results provide the proof-of-concept for a larger randomized controlled trial of fosfomycin in the treatment of prostatitis. In the meantime, this study may be used to support initiating fosfomycin in a patient with contraindications to one of the available oral alternatives for prostatitis.
mike588 derek76
Posted
Interesting, one thing I'd like to know is how does one know if they have Prostatitis vs UTI ? Or maybe you could have both? Or maybe a mild case of prostatitis?
derek76 mike588
Posted
That also seems to be your doctors dilemma
When I've been treated for prosatitis it has never been proved by tests just assumed to be. It's a strangely named disease when there can bacterial and non bacterial versions and Asymptomatic Inflammatory Prostatitis or is that the same as non bacterial?
ian30145 derek76
Posted
I had a semen test - which I insisted on having - which allegedly found heavy growth of enterococcus faecilis and no fungal overgrowth - so I was prescribed a 6 week course of amoxicillin
I lasted 7 days on it - gave up because the scrotal inflammation, burning urination and constipation became much worse. So much for their tests; wish to god I had never taken amoxicillin - I'm sure my issues are fungal and taking antibiotics amounts to pouring petrol on the flames
derek76 ian30145
Posted
What will be tried next ?
ian30145 derek76
Posted
Given that I very strongly suspect my issues are fungal in nature - years ago I reacted very adversely to erythromycin and more recently to doxycycline - I believe the anti-fungal diflucan. I managed to obtain some from my GP and I got some from India - ordered online.
I have been taking the advice of a yeast infection specialist in the US, she's a Phd and has written a book on the subject
She's advised taking 200mg per day - there is some evidence that this approach can be very successful
derek76 ian30145
Posted
You have spread your net well.
Any difficulties when ordering online from India and are you confident with the quality from India?
ian30145 derek76
Posted
Thanks - I'm also contemplating the removal of the infected gland - which I feel fell to a deadly combo of prescription antibiotics and too much beer months later down the track
It was remarkably to get hold of pills from India; here in under a week. I'm not 100% confident on quality no, how can you be! Seems plausible as far as I can tell. This is a major factor in my decision as to whether to take them or not - I've made too many stupid mistakes as it is; though of course one couldn't exactly describe the medical guidance I've had as ideal. GP's I've got couldn't diagnose their way out of a paper bag and they seem very resistant to take on board new info however credible its provenance.
What your situation Derek? Still sufferering or did you find an answer?
derek76 ian30145
Posted
Have you discussed the possible surgery with your urologist yet ?
Fingers crossed I've not had another infection since my last laser surgery in 2012 and my PSA is now 0.70. That part of life is much better but I'm suffering from the prostate infection medications:-) As reported in other posts I was three times prescribed Cipro and Fluoroquinolones that initially caused tendonitis and have caused later long term damage by way of neuropathy in lower left leg and foot causing me walking problems.
I'll PM you for the name of your Indian pharmacist as I need an expensive item (Metvix) for my keratoses sun damage that the NHS will not prescribe.
ian30145 derek76
Posted
Going to be discussing possible removal with Consultant on Tuesday - top man in field apparently. Sorry to hear about your collateral damage; I've heard some bad things about Cipro etc - that's shocking