Chronic bacterial prostatitis - Video Learning - lostpod.it
Ellis, Phillip T. Zeglinski, Nicholas H. Hewitt, Bradley E. coli prostatite. Gardiner, Albert G. Treatment options for e. coli prostatite caused by multidrug-resistant gram-negative bacilli are limited. We report two cases cured with oral fosfomycin and provide a pharmacokinetic analysis of fosfomycin predose concentrations during treatment.
See the Editorial Commentary by Falagas and Rafailidis on pages —6. Prostatitis is a difficult infection to treat due to the poor penetration of many antimicrobials into prostatic tissue [ 12 ]. Antimicrobial options are limited and prolonged courses of therapy 6—12 weeks are required, e. coli prostatite fluoroquinolones being cornerstones of therapy [ 3 ]. The increasing incidence of multidrug-resistant gram-negative bacilli MDR-GNB worldwide has had an impact on the microbial epidemiology of prostatitis [ 45 ].
Fluoroquinolone resistance further limits oral treatment options for prostatitis and sometimes mandates long-term parenteral therapy with high rates of relapse in many patients [ 2 ].
Fosfomycin is an attractive alternative for the treatment of prostatitis because of its high oral bioavailability and ability to attain therapeutic levels in prostatic tissue [ 67 ]. Although the use of fosfomycin for treatment of prostatitis has been reported previously, parenteral agents were frequently coadministered [ 18—11 ], such that there is a paucity of information regarding the appropriate fosfomycin dosing regimen [ 12 ] and the drug's tolerability and long-term outcomes.
We report the successful treatment of 2 patients with MDR-GNB prostatitis with oral fosfomycin in whom detailed pharmacokinetic monitoring e. coli prostatite identification of an effective fosfomycin treatment regimen. He had a past history of recurrent urinary tract infections UTIs and 10 weeks prior had undergone a transrectal ultrasound TRUS —guided biopsy of the prostate to investigate an elevated prostate-specific antigen PSA level and possible prostatic malignancy.
Soon after the biopsy he developed high fevers, dysuria, and frequency. His biopsy sample showed focal acute and chronic prostatitis but no malignancy. He was treated for prostatitis with meropenem 1 g intravenously every 8 hours for 2 weeks, followed by outpatient parenteral therapy with ertapenem 1 g daily for 4 weeks.
Two weeks following completion of this 6-week course, the patient had a relapse with recurrence of his symptoms. ESBL E. He was transferred to our hospital and initially recommenced on meropenem 1 g every 8 hours, with an improvement in his symptoms and inflammatory markers and clearance of bacteriuria.
Computed tomography and TRUS imaging of his prostate again demonstrated prostatomegaly but no intraprostatic collection, and his PSA level remained elevated Within 36 hours of the increase in dose frequency, the patient developed prominent fecal urgency and diarrhea 2—3 bowel movements dailywhich was repeatedly e. coli prostatite for diarrheal pathogens, including Clostridium difficileand could not be controlled with loperamide. After 5 days of twice-daily therapy, the fosfomycin dose was reduced to 3 g once daily, with prompt resolution in the patient's symptoms.
The patient subsequently completed a total course of 16 weeks of oral fosfomycin 15 weeks, 2 days of 3 g once daily; 5 e. coli prostatite of 3 g twice daily without incident and was clinically and microbiologically cured 6 months after treatment completion.
He e. coli prostatite a past history of recurrent UTIs and urethral strictures requiring flexible cystoscopy and had recently traveled to Thailand.
He was initially treated with fosfomycin 3 g every e. coli prostatite hours for 2 weeks [ 13 ]. Five days after cessation of therapy, he had e. coli prostatite recurrence of dysuria, polyuria, and malodorous urine; e. coli prostatite urine culture once again isolated ESBL E. Computed tomography of the prostate showed e.
coli prostatite but no abscess. Acute prostatitis was clinically diagnosed, and he was recommenced on oral fosfomycin, this time e. coli prostatite a dose of 3 g once daily.
Predose trough plasma fosfomycin concentrations were measured e. coli prostatite during therapy. The patient successfully completed 12 weeks of fosfomycin therapy with no significant adverse effects. He had no clinical or microbiologic evidence of recurrence at 6 months of follow-up.
E. coli prostatite fosfomycin levels were assessed on both patients using methods previously described [ 5 ]. The timing of plasma samples relative to each dose was recorded to allow a pharmacokinetic analysis of dosing and especially to identify trough 0—3 hours predose concentrations, as they were considered likely to represent steady-state intraprostatic levels [ 5 ].
After prolonged 6 months follow-up, both patients with MDR prostatitis have been clinically and microbiologically cured with oral fosfomycin 3 g once daily. For patient 1, 19 samples were collected 1 pretreatment; 13 trough samples after fosfomycin 3 g once daily; 2 were e.
coli prostatite For patient 2, 10 trough samples were collected after 3 g once daily. Results for both patients are summarized in Figure 1 and Supplementary Table 1. Trough plasma fosfomycin levels during therapy for prostatitis. Measurements were done on 23 e. coli prostatite from 2 patients for fosfomycin 3 g once daily patient e. coli prostatite, open squares; patient 2, closed circles and on 3 samples from 1 patient e. coli prostatite fosfomycin 3 g twice daily patient 1, open triangles.
Mean trough plasma fosfomycin concentrations during therapy with 3 g once-daily and 3 g twice-daily dosing were 5. This report is notable because it suggests that e.
coli prostatite 12—16 weeks monotherapy with oral fosfomycin 3 g once daily e. coli prostatite effective in selected e. coli prostatite with MDR but fosfomycin-susceptible E.
Although it is hard to extrapolate the intraprostatic fosfomycin concentrations associated with this dosing regimen, it is likely that with prolonged therapy, steady-state concentrations that are similar to the observed trough plasma values are achieved [ 5 ]. We have previously found prostate fosfomycin levels of 6. Although fosfomycin has few toxicities or drug interactions, we found the twice-daily dose to be poorly tolerated, in keeping with previous reports [ 14 ].
However, the twice-daily dose was associated with significantly higher trough plasma fosfomycin concentrations. In most previous case reports of successful fosfomycin treatment of prostatitis, combination regimens were used including doxycycline [ 1 ], ertapenem [ 9 ], and aztreonam [ 10 ].
Similar to others [ 1 ], we found the dose e. coli prostatite routinely recommended for UTI 3 g every 72 hours [ 13 ] to be ineffective.
The single previous successful case report of fosfomycin monotherapy for prostatitis required parenteral administration e.
coli prostatite 8 ]. This study has some limitations. Second, given that both our cases had infection due to E. Finally, although patient 2 had clinical symptoms highly suggestive of prostatitis, he did not have biopsy confirmation as in patient 1. The authors thank the patients for their participation. Potential conflicts of interest. All authors: No potential conflicts of interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
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Oxford Academic. Google Scholar. Nenad Macesic. Janine Trevillyan. Andrew G. Phillip T. Nicholas H. Bradley J. Albert G. Cite Citation. Permissions Icon Permissions. Abstract Treatment options for prostatitis caused by multidrug-resistant gram-negative bacilli are limited.
Figure 1. Open in new tab Download slide. Search ADS. Clinical and microbiological determinants of infection after transrectal prostate biopsy. Editorial commentary: fluoroquinolone-resistant intestinal organisms and infections after prostate biopsy: shifting sands of the prevention narrative. Is fosfomycin a potential treatment alternative for multidrug-resistant gram-negative prostatitis?
Transference of antibiotics into prostatitic tissues: sampling method by transurethral resection for the measurement of concentration of antibiotics in the prostatic tissues [in Japanese]. Treatment of a complicated vancomycin-resistant enterococcal urinary tract infection with fosfomycin.
Optimal timing of oral fosfomycin administration for pre-prostate biopsy prophylaxis. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Infectious complications following transrectal ultrasound-guided prostate biopsy: new challenges in the era of multidrug-resistant Escherichia coli.
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