Int J Antimicrob Agents. 2020 Jul 25:106106. doi: 10.1016/j.ijantimicag.2020.106106. Online ahead of print.
There has been growing interest in fosfomycin for the treatment of bacterial prostatitis due to evidence suggesting it achieves adequate prostatic concentrations for antimicrobial effect, its activity against resistant microorganisms, and its low-toxicity profile. This review evaluated the current clinical evidence for fosfomycin in acute and chronic bacterial prostatitis to elucidate the clinical implications of fosfomycin in an era of increasing antimicrobial resistance. PubMed, Scopus, EMBASE, Web of Science, Google Scholar, and ClinicalTrials.gov were searched for studies published in the English language from January, 1984 to November, 2019. The inclusion criteria were met if the study reported on fosfomycin use in bacterial prostatitis treatment in which more than one dose of fosfomycin was given. Ten observational studies were identified that met the inclusion criteria. The evidence for using fosfomycin in acute bacterial prostatitis is sparse. The majority of the available evidence is for chronic bacterial prostatitis caused by Escherichia coli. Despite variable dosing regimens implemented, extended courses of fosfomycin appeared safe and effective in achieving clinical and microbiological cure. In these studies, the use of fosfomycin was restricted to cases of treatment failure, intolerance to first-line therapy, or multi-resistant organisms. However, given the development of resistant organisms and the undesirable adverse effects of many first-line therapeutic options, fosfomycin has the potential to be considered as an effective first-line alternative for acute and chronic bacterial prostatitis in the future. Further studies, including randomized controlled trials, would be helpful to more firmly establish its optimal dosing regimen, efficacy, and place in therapy.