FOSFOMYCIN may offer a viable treatment alternative for bacterial prostatitis, particularly in patients with multidrug-resistant infections, according to a new systematic review. The findings highlight fosfomycin’s clinical and microbiological effectiveness alongside a favorable safety profile, supporting its use in cases where standard antibiotics have failed.
Bacterial prostatitis significantly impairs patients’ quality of life and remains a challenging condition to treat due to variable antibiotic resistance. The review, led by Kontogiannis DS et al., evaluated the use of fosfomycin in adult patients with acute and chronic bacterial prostatitis. Drawing from four cohort studies, one phase I–II trial, and a dozen case reports, the researchers assessed outcomes including clinical and microbiological cure, recurrence, and adverse events.
Among 99 patients with chronic bacterial prostatitis across four studies, 73% achieved clinical cure and 78% achieved microbiological cure. Adverse events were reported in 15% of these cases, most of which were mild. In a single study focusing on acute bacterial prostatitis, all 18 patients achieved clinical resolution, while 92% showed microbiological clearance. Only 11% reported adverse effects.
Additional insights from 12 case reports support these trends. Of the five chronic cases, two patients experienced both clinical and microbiological cure, with one reporting mild side effects. All eight acute cases achieved clinical cure, and 75% had microbiological clearance. Again, adverse events were minimal.
These results suggest that fosfomycin may be particularly useful when treatment options are limited due to antibiotic resistance. Its activity against common uropathogens and ability to penetrate prostatic tissue positions it as a potential agent in both acute and chronic presentations of the disease.
However, the authors caution that the limited number of high-quality studies and relatively small patient population warrant further investigation. They call for more rigorous clinical trials to clarify fosfomycin’s safety and efficacy in this context and to inform future treatment guidelines.
Reference:
Kontogiannis DS et al. Fosfomycin for the treatment of patients with bacterial prostatitis: a systematic review. Eur J Clin Microbiol Infect Dis. 2025. doi: 10.1007/s10096-025-05173-x. [Online ahead of print].
