Τίτλος:
Oral fosfomycin for the treatment of chronic bacterial prostatitis
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background: Chronic bacterial prostatitis (CBP) is a difficult-to-treat infection as only a few antibiotics achieve therapeutic concentrations in the prostate. Data on the efficacy and safety of oral fosfomycin for the treatment of CBP are limited. Objectives: To analyse the efficacy and safety of fosfomycin in CBP due to MDR pathogens. Methods: In a prospective observational study, an oral regimen of 3 g of fosfomycin q24h for 1 week followed by 3 g q48h for a treatment duration of 6-12 weeks was administered. The outcome was clinical and microbiological cure rate at the end of treatment (EOT) and rate of relapse at 3 and 6 months. Results: The study included 44 patients. The most common pathogen was Escherichia coli (66%), followed by Klebsiella spp. (14%) and Enterococcus faecalis (14%). Most strains were MDR (59%) and 23% had an ESBL phenotype; 33 of 44 strains were resistant to fluoroquinolones, but all were susceptible to fosfomycin (median MIC for Gram-negative pathogens 1.5 mg/L). In 25 patients, treatment was administered for 6 weeks, whereas in the remaining 19 patients it was prolonged to 12 weeks based on the presence of calcifications in the prostate. Cure rate was 82% at EOT and 80% and 73% at 3 and 6 months accordingly. Microbiological eradication was achieved in 86% and 77% at EOT and at 6 months, respectively. Failure was observed in 12 patients. The most common adverse event was diarrhoea (18%). Conclusions: Oral fosfomycin, particularly in the era of MDR prevalence, represents an attractive, safe and effective alternative to fluoroquinolones for the treatment of CBP. © 2019 The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.
Συγγραφείς:
Karaiskos, I.
Galani, L.
Sakka, V.
Gkoufa, A.
Sopilidis, O.
Chalikopoulos, D.
Alivizatos, G.
Giamarellou, E.
Περιοδικό:
The Journal of antimicrobial chemotherapy
Εκδότης:
Oxford University Press
Λέξεις-κλειδιά:
adrenergic receptor blocking agent; extended spectrum beta lactamase; fosfomycin; fosfomycin trometamol; minocycline; quinolone derivative; sulfamethoxazole; trimethoprim; antiinfective agent; fosfomycin, adult; aged; Article; bacterial clearance; chronic bacterial prostatitis; chronic bacterial prostatitis; clinical article; clinical effectiveness; diarrhea; disease eradication; drug efficacy; drug safety; drug withdrawal; Enterococcus faecalis; Escherichia coli; follow up; human; infectious agent; Klebsiella; male; microbiological examination; multidrug resistance; observational study; outcome assessment; phenotypic variation; prevalence; prospective study; prostatic calcification; prostatitis; Pseudomonas aeruginosa; relapse; treatment duration; treatment indication; very elderly; chronic disease; drug effect; microbial sensitivity test; microbiology; middle aged; multidrug resistance; oral drug administration; prostatitis, Administration, Oral; Adult; Aged; Anti-Bacterial Agents; Chronic Disease; Drug Resistance, Multiple, Bacterial; Enterococcus faecalis; Escherichia coli; Fosfomycin; Humans; Klebsiella; Male; Microbial Sensitivity Tests; Middle Aged; Prospective Studies; Prostatitis
