Acute and chronic bacterial prostatitis in outpatients is commonly treated with oral fluoroquinolones; however, the worldwide\ndissemination of multidrug-resistant (MDR) Escherichia coli has resulted in therapeutic failures with fluoroquinolones. We\nreviewed the literature regarding the use of oral fosfomycin in the treatment of acute and chronic prostatitis caused by MDR\nE. coli. All English-language references on PubMed from 1986 to June 2017, inclusive, were reviewed from the search\nââ?¬Å?fosfomycin prostatitis.ââ?¬Â Fosfomycin demonstrates potent in vitro activity against a variety of antimicrobial-resistant E. coli\ngenotypes/phenotypes including ciprofloxacin-resistant, trimethoprim-sulfamethoxazole-resistant, extended-spectrum Ã?²-lactamase-\n(ESBL-) producing, and MDR isolates. Fosfomycin attains therapeutic concentrations (ââ?°Â¥4 Ã?¼g/g) in uninflamed prostatic tissue and\nmaintains a high prostate/plasma ratio up to 17 hours after oral administration. Oral fosfomycinââ?¬â?¢s clinical cure rates in the\ntreatment of bacterial prostatitis caused by antimicrobial-resistant E. coli ranged from 50 to 77%with microbiological eradication\nrates of >50%. An oral regimen of fosfomycin tromethamine of 3 gÃ?·q 24 h for one week followed by 3gÃ?·q 48 h for a total treatment\nduration of 6ââ?¬â??12 weeks appeared to be effective. Oral fosfomycin may represent an efficacious and safe treatment for acute and\nchronic prostatitis caused by MDR E. coli.
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