Dealing with Doctors / Fosfomycin for Prostatitis
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Author:  Metanoia [ Wed Feb 01, 2017 5:35 am ]
Post subject:  Dealing with Doctors / Fosfomycin for Prostatitis

Despite recent research and studies regarding fosfomycin’s ability to penetrate the prostate and effectively treat even resistant organisms, little progress has been made on adopting it for routine initial therapy.

Doctors tend to prefer their tried and true meds (sulfa & quinolones), despite growing bacterial resistance to these medications and difficulties getting accurate culture and sensitivity to pathogens in the prostate.

In the US, doctors are forced to practice “defensive medicine” due to the risk of medical litigation. As sulfa and quinolone meds are approved by the FDA for treating bacterial (or even suspected bacterial) prostatitis, doctors face NO risk from prescribing them; this despite increasing concerns about “persistent and disabling” side effects from fluoroquinolone meds and the notorious reputation for serious allergic reactions to sulfa; yet for prostatitis, these meds are still considered appropriate as an initial therapy despite evidence of effective therapy from a substantially more benign medication!

Fosfomycin, a much more benign med is approved by the FDA only for treating uncomplicated urinary infections, primarily in pregnant women. The fact that it appears to be remarkably effective, even against resistant organisms in “experimental” studies for prostatitis doesn’t change the fact that it is not yet “accepted” as a front line treatment / initial option by the FDA. This means fosfomycin is considered the “medication of last resort”, despite it being substantially safer and possibly more effective than current first line treatment options.

For the doctor, this means if he prescribes fosfomycin as an initial treatment and it fails (sepsis or chronic infection) occur, he may be at risk for litigation. For the patient, this means YOU will be obliged to incur substantially greater risk of side effects from inherently riskier therapy in order to protect your doctor from his risk of prescribing fosfomycin “off label”.

“Off Label” prescribing of drugs is not illegal or unusual… ... -label_use

“Up to one-fifth of all drugs are prescribed off-label”

Here’s what the FDA has to say about off-label use of approved medications: ... 041767.htm

Thus we see, approaching your doc about fosfomycin as an initial therapy option would not be illegal or unusual, particularly as it is a safer and more benign therapy option. There is no “cross-resistance” between fosfomycin and other antibiotics (Bactrim/Cipro), so initial fosfomycin therapy can not sabotage future therapies with sulfa or quins.

There is a theoretical issue with a failed initial attempt at therapy with fosfomycin resulting in a bacterial infection becoming “more established” and therefore resistant to further treatment with currently approved antibiotics, but I expect this would pertain primarily to “acute” prostatitis, and not chronic bacterial prostatitis. Once a bacterial infection becomes “chronic”, time is not of the essence.

So what will it be then? If you’ve got a positive culture and sensitivity indicating your infection is not resistant to current therapy recommendations (sulfa/quins), do you go with the increased risk of persistent and disabling side effects (quins), or potentially serious allergic reaction (sulfa)? Or do you push hard for a far more benign medication that is increasingly showing it can give similar results?

If you do not have a positive culture and sensitivity, but your doctor merely “suspects” bacterial prostatitis; will you embark on a month or more of sulfa or quins, not even knowing if your bug might be resistant to them?

This is something every patient (and I would hope doctors too!) would consider, before writing off fosfomycin as a valid initial therapy. There is very little to lose, and perhaps much unpleasantness to to be avoided.

Author:  Metanoia [ Wed Feb 01, 2017 3:27 pm ]
Post subject:  Re: Dealing with Doctors / Fosfomycin for Prostatitis

There are many reports of successful treatment of resistant prostatitis with fosfomycin. Here are a couple of papers from legitimate sources you may wish to print and take with you when you see your doctor for treatment.

Fosfomycin An Option for Prostatitis (from renal & urology news) ... le/439348/

Fosfomycin an Old Drug With New Tricks for Prostatitis (from Medscape) ... cle/851302

If your doctor poo-poo’s your desire to pursue a safer option to sulfa or quins, you might ask him “what’s the plan” if you do experience the persistent / disabling side effects the FDA describes in its literature regarding quinolones, or serious allergic reactions (including liver failure) with sulfa. Will he be the one attempting to resolve these problems? Or will he send you packing back to your GP to try and regain your health?

When I put my concerns on these matters to my doctor (documentation in hand) and argued aggressively for this “kinder/gentler” therapy as an initial attempt at treatment, he “humored” me with a scrip for fosfomycin, and low and behold, it worked! Quite frankly I’m shocked at the lack of evolution in treatment now that fosfomycin has been “discovered” to penetrate the prostate well and treat even resistant organisms, with far less risk than sulfa or quins.

Fosfomycin doesn’t work for everyone (much like quinolones and sulfa) but it would seem a logical first choice treatment option (my humble opinion).

Author:  Inflamed [ Wed Feb 01, 2017 7:36 pm ]
Post subject:  Re: Dealing with Doctors / Fosfomycin for Prostatitis

Meta, how did you take it, were they pills, or the powdered solution? How much per day, how many days?

Author:  prostate454 [ Wed Feb 01, 2017 8:27 pm ]
Post subject:  Re: Dealing with Doctors / Fosfomycin for Prostatitis

Another question. What bacteria was identified on your culture and also what sensitivities were tested?

Author:  Metanoia [ Wed Feb 01, 2017 9:41 pm ]
Post subject:  Re: Dealing with Doctors / Fosfomycin for Prostatitis

I had a positive culture for haemophilus that was beta-lactam resistant (beta lactamase positive), but the growth was too small to get a proper sensitivity. There's a different protocol for haemophilus cultures that involves enriched C02 atmosphere for better growth.

I took Monurol brand Fosfomycin in the 3 gram "sachet". A powder you mix with cool water. I dosed at once a day for 5 days and then every 48 hours for another 3 weeks. I wanted to continue the aggressive (daily) dosing as I was not getting any side effect from this, but my uro wanted me on less frequent dosing. I don't believe he was confident in fosfo therapy and was only letting me try it to humor me.

I convinced him to let me try it only by telling him I was a daily drinker and perhaps "alcohol dependent", which ruled out sulfa; and that I already suffered tendinopathies in my shoulder and plantar fascia, & I would be hopping-mad if these got worse with quinolones.

In reading through the monograph on fosfomycin, I learned the drug is actually absorbed into urinary tissue directly through the urine, and not so much from blood concentrations. The kidneys filter fosfo out of the blood so fast it is impossible to keep blood levels up through oral dosing, but as the fosfo rich urine sits in the bladder, it penetrates surrounding tissue quite well and this is why fosfo is only used for urinary infections.

I reckoned by taking my fosfo at night, shortly before bed and on a fairly empty stomach, I might get better tissue concentrations, as the fosfo rich urine would sit longer in my bladder. Fluid throughput and urination are less overnight and I hoped this would result in higher concentrations. I did this because my doc refused daily dosing and in one of the papers I linked to (Fosfomycin an Old Drug With New Tricks for Prostatitis) Dr Grayson opined 48 hour dosing might not provide continuous therapeutic levels.

Don't know if my nocturnal dosing made any difference, but it seemed logical to me! The literature you can take it any time, with or without food, but absorption is less rapid if you take it with meals and peak concentrations lower. I know many of us have learned the hard way taking antibiotics on an empty stomach can be bad news, but this is NOT TRUE with fosfomycin. I always took mine on an empty stomach, half an hour before bed and never had a problem, so please don't be afraid to try this.

Author:  Inflamed [ Thu Feb 02, 2017 2:50 am ]
Post subject:  Re: Dealing with Doctors / Fosfomycin for Prostatitis

Wow, that's an awesome post, thanks Meta!

Author:  Metanoia [ Fri Feb 03, 2017 1:36 am ]
Post subject:  Re: Dealing with Doctors / Fosfomycin for Prostatitis

Thanks Inflamed. I'm about done crowing about my fosfomycin miracle cure, but wanted to help those who want to try it.

I realize my haemophilus infection was atypical... I'm just so glad I got to avoid rolling the dice with sulfa/Cipro, I can't help shouting about it from the roof-tops.

Godspeed, & Best of Luck to you all!

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