Fosfomycin Tromethamine

To study the efficacy of fosfomycin trometamol (FT) as prophylaxis for recurrent urinary tract infections (UTI) in a population not targeted by guidelines.

Retrospective, monocenter study of patients taking FT prophylaxis for recurrent UTI. We compared the incidence of UTI during the six months prior to and the six months following the initiation of prophylactic treatment with FT.

a total of 86 patients were enrolled in the study, including 20 men and 66 women, with a median age of 56.5 years [44-70]. Forty-one had underlying urological diseases, and 24 were immunocompromised, including 16 kidney transplant recipients. FT prophylaxis was associated with a dramatic decrease in the incidence of UTI on multivariate analysis, with an incidence rate ratio of 0.15 [0.11-0.20] in women, and 0.05 [0.02-0.16] in men. Adverse events were reported by 12(13.9%) patients, leading to FT discontinuation in 3(3.4%).

FT prophylaxis was associated with a 85-95% reduction in the incidence of UTI in patients with recurrent UTI and predisposing conditions.

The management of male urinary tract infections (UTIs) has historically been based on a monolithic approach, under which every episode was treated as acute prostatitis, leading to prolonged antibiotic courses. To address rising bacterial resistance and promote antimicrobial stewardship, the French Infectious Diseases Society (SPILF) updated its guidelines in 2026, introducing a stratified management framework. This review outlines the scientific evidence underlying these updated recommendations. A comprehensive review of recent literature, including randomized controlled trials and large-scale retrospective cohorts, was conducted so as to evaluate antibiotic efficacy, resistance patterns, and optimal treatment durations for male cystitis, febrile UTIs (prostatitis/pyelonephritis), and acute epididymo-orchitis. Evidence validates distinguishing male cystitis from febrile UTI. For male cystitis, 7-day regimens using narrow-spectrum oral agents-such as fosfomycin trometamol, nitrofurantoin, or pivmecillinam-achieve satisfactory clinical success with minimal risk of complications. Conversely, febrile UTIs require initial parenteral third-generation cephalosporins or oral fluoroquinolones. For targeted oral step-down therapy in prostatitis, cotrimoxazole is preferred over fluoroquinolones so as to minimize ecological impact, while amoxicillin remains the drug of choice for enterococcal coverage. Although recent data show that seven days can be sufficient for selected bacteremic presentations, to prevent relapses a conventional 14-day duration remains the standard for acute prostatitis. Non-sexually transmitted orchitis and epididymitis require a 10-day course of fluoroquinolones or cotrimoxazole. The 2026 SPILF guidelines represent a paradigm shift toward a tailored, stratified approach.