Trometamol 4.03% infusion 100ml bags

ObjectivesTo determine whether oral fosfomycin trometamol is noninferior to carbapenem continuation as step-down therapy for cUTIs caused by third-generation cephalosporin-resistant Enterobacterales.MethodsIn this open-label, randomized, noninferiority trial, adults with 3GCRE cUTIs who received 3 days of intravenous carbapenem were assigned to oral fosfomycin trometamol or continued carbapenem to complete 7 days. The primary outcome was day-7 clinical cure; secondary outcomes included day-28 clinical and microbiological cure, readmission, and length of stay.ResultsA total of 124 participants were enrolled (62 per group). The mean age was 73 years, 62.1% were female, and Escherichia coli accounted for 91% of isolates. Clinical cure at day 7 occurred in 98.4% in both groups (risk difference 0.0; 95% CI, -0.04 to 0.04). Clinical cure at day 28 was also similar (91.9% in each group). Microbiological cure at day 7 was 100% with fosfomycin and 98.1% with carbapenem, and at day 28 was 90.3% and 85.5%, respectively. Hospital stay was shorter with fosfomycin (7.9 vs 12.0 days).ConclusionsOral fosfomycin trometamol as step-down therapy was comparable to continued carbapenem therapy for cUTIs caused by 3GCRE and significantly reduced hospital stay, supporting role of carbapenem-sparing option.

Abstract licence: CC BY

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.

Abstract licence: CC BY