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Randomized, Multicenter, Non-inferiority Trial Comparing the Efficacy of Fosfomycin Versus Fluoroquinolones or Cotrimoxazole as Oral Follow-up Treatment in Febrile Urinary Tract Infections in Men Caused by Susceptible Enterobacteria (FOSFORMEN)

5. november 2026 opdateret af: Assistance Publique - Hôpitaux de Paris

Essai randomisé, Multicentrique, de Non-infériorité Comparant l'efficacité d'un Traitement Par Fosfomycine Versus Fluoroquinolones ou Cotrimoxazole en Relais Oral Dans Les Infections Urinaires Masculines fébriles Dues à Escherichia Coli

The fosfomycin-trometamol (FT) combination demonstrates microbiological efficacy against the vast majority of Escherichia coli strains responsible for urinary tract infections (UTIs). Moreover, approximately 99% of strains exhibiting multidrug resistance remain suceptible to fosfomycin.

The clinical tolerance profile of this molecule is excellent and has been well established since its market authorization in 1989 for the treatment of cystitis in women.

Its pharmacokinetic and pharmacodynamic properties are compatible with its use in the treatment of UTIs in men.

However, the clinical efficacy of FT (oral fosfomycin) in the treatment of febrile UTIs in men has never been evaluated in prospective trials. FT could represent an innovative treatment option in such cases, offering the use if an antibiotic with significantly fewer side effects than those currently recommended.

The main objective of the trial is to demonstrate that FT is not inferior to fluoroquinolones (FQ) or cotrimoxazole (TMP-SMX) as oral step-down therapy in prostatitisfebrile male urinary tract infections caused by Escherichia coli.

Studieoversigt

Status

Ikke rekrutterer endnu

Betingelser

Intervention / Behandling

Undersøgelsestype

Interventionel

Tilmelding (Anslået)

312

Fase

  • Fase 3

Kontakter og lokationer

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Studiekontakt

Undersøgelse Kontakt Backup

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år og ældre (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Han

Beskrivelse

Inclusion Criteria:

  • Male
  • Age ≥ 18
  • Body temperature ≥ 38°C within the 72 hours preceding the diagnosis of UTI
  • At least one of the following symptoms : dysuria, higher urinary frequency, urgency, hematuria, suprapubic pain, prostatic pain, or perineal pain
  • Positive urine microbiological examination (urine culture) : Sample collected before initiation of the empiric antibiotic therapy, ≥ 10 leukocytes/µL, and monomicrobial culture positive for E. coli with bacteriuria ≥ 103 CFU/mL
  • The strain must be suceptible to fosfomycin and to either FQ or TMP-SMX according to EUCAST
  • The strain must be suceptible to the empiric antibiotic therapy received
  • Ability to take oral treatment
  • Favorable clinical evolution after receiving effective empiric antibiotic therapy for 72 ± 24 hours ; Favorable evolution is defined as body temperature < 38°C with clinical improvement or resolution of the clinical signs and symptoms of urinary tract infection present at diagnosis, including the absence or improvement of dysuria, pollakiuria, urinary urgency, hematuria, suprapubic, prostatic, or perineal pain, urethral pain during urination, and/or a burning sensation during urination.

Exclusion Criteria:

  • Presence of another condition that could explain the fever
  • Septic shock of urinary origin
  • Need for a urological procedure
  • Anatomical abnormalities of the urinary tract (e.g., urinary prostheses and implants [except JJ], Bricker, neobladder, total prostatectomy, uretrestomy, nephrostomy, urinary fistula)
  • Presence of an indwelling urinary catheter, except of placed during the current UTI episode
  • Neurogenic bladder
  • Immunosupression
  • Contraindication to the use of FQ , TMP-SMX or FT
  • Severe chronic kidney disease with an estimated flomerular filtration rate < 20 mL/min
  • UTI treated within the past 3 months
  • High probability of death within 3 months
  • Major cognitive disorders
  • Patients deprived of their liberty by judicial or administrative decision, under guardianship or curatorship
  • Lack of social security coverage
  • Absence of written informed consent
  • Participation in another interventional research protocol
  • Absence of written informed consent
  • Participation in another interventional research protocol
  • Patients deprived of their liberty by a judicial or administrative decision

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Enkelt

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: Fosfomycin-trometamol (FT)

Oral dose : 3g Fosfomycin-trometamol once daily

Aktiv komparator: Reference treatments as per the French SPLIF guidlines

Reference treatments will bet hose recommended by the French SPLIF guidlines :

  • Oral FQ : three molecules are authorized ; ofloxacin, ciprofloxacin and levofloxacin
  • TMP-SMX

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Clinical cure
Tidsramme: At day 26

Defined as body temperature < 38°C and absence of urinary tract infection symptoms, without the need for additional antibiotic therapy up to the primary evaluation on Day 26, which corresponds to 14 days after completion of a 12-day antibiotic treatment assigned by randomization.

At day 26

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Cumulative incidence of infectious and urological complications
Tidsramme: Up to day 40
Up to day 40
Adherence to treatment
Tidsramme: Up to day 40
Up to day 40
Occurence of adverse events related to anticiotics
Tidsramme: Up to day 40

Occurrence, nature, and severity of adverse events

Up to day 40
Rectal carriage of phenotypically antibiotic-resistant Enterobacterales
Tidsramme: At day 26

Carriage of Enterobacterales resistant to FQ, TMP-SMX, fosfomycin, and third-generation cephalosporins on Day 26, i.e., 14 days after completion of the randomized antibiotic treatment Binary outcome

At day 26
Rates of recurrence of febrile or non-febrile UTIs (relapse or reinfection)
Tidsramme: At day 40

Assessed on Day40, i.e., 28 days after completion of the randomized antibiotic treatment

  • UTI : reappearance of urinary symptoms with a positive urine culture (ECBU)
  • Febrile UTI : fever or urinary origin with a positive urine culture
  • Relapse : new infection caused by the same bacteria than as the initial episode
  • Reinfection : new infection caused by a different bacteria than the initial episode
At day 40
Number of patients who experienced treatment failure
Tidsramme: Up to day 40

Clinical and biological characteristics of patients who experienced treatment failure compared to those who were cured during the initial episode

Up to day 40

Samarbejdspartnere og efterforskere

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Sponsor

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Anslået)

1. december 2026

Primær færdiggørelse (Anslået)

26. december 2029

Studieafslutning (Anslået)

15. januar 2030

Datoer for studieregistrering

Først indsendt

2. november 2026

Først indsendt, der opfyldte QC-kriterier

5. november 2026

Først opslået (Faktiske)

12. november 2026

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

12. november 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

5. november 2026

Sidst verificeret

1. november 2026

Mere information

Begreber relateret til denne undersøgelse

Andre undersøgelses-id-numre

  • APHP240801

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