FOSFOMYCIN TROMETAMOL AND N-ACETYL-L-CYSTEINE AS COMBINED ORAL THERAPY OF DIFFICULT-TO-TREAT CHRONIC BACTERIAL PROSTATITIS: RESULTS OF A PILOT STUDY.

This paper presents the results of a pilot study of difficult-to-treat patients (exhibiting several previous treatment failures or detection of ESBL strains) with chronic bacterial prostatitis (CBP) who underwent treatment with fosfomycin trometamol (FT) associated with N-acetyl-L-cysteine (NAC). Twenty-eight patients with clinically and microbiologically confirmed CBP, attending a single Urological Institution between January 2018 and March 2019, were treated with oral administration of 3 g FT once a day for two days and then a dose of 3 g every 48 h for two weeks, in combination with oral administration of NAC 600 mg once a day for two weeks. Clinical and microbiological analyses were carried out at the time of admission (T0) and during follow-up at 1 month (T1) and 6 months (T2) after the treatment end. Symptoms were assessed by the NIH Chronic Prostatitis Symptom Index (CPSI) and International Prostatic Symptom Score (IPSS), and quality of life was assessed by Quality of Well-Being (QoL) questionnaires. Isolated strains were: Escherichia coli (23 patients), Enterococcus spp. (3 patients), Klebsiella oxytoca (2 patients). ESBL strain was found in 19 patients (67.8%). Microbiological eradication was documented in 21 (75%) patients at the second follow-up visit while clinical cure was reached in 20 (71.4%) patients. Significant changes in terms of questionnaires were recorded between baseline and follow-up visits. Fifteen out of 19 patients (78.9%) with ESBL strains were cured. No significant side effects were reported. Fosfomycin trometamol in combination with N-acetyl-L-cysteine is a promising alternative therapy in difficult-to-treat CBP patients.