Background <p>Bacterial prostatitis is a common infection affecting the patient’s quality of life. It is caused by various bacteria, including multidrug-resistant Enterobacterales. Fosfomycin is active against most implicated pathogens, has good penetration in the prostate, and thus, has been used in patients with bacterial prostatitis.</p> Methods <p>A systematic review of studies assessing the effectiveness of fosfomycin in adult patients with bacterial prostatitis. The primary outcome was clinical cure and secondary outcomes were microbiological cure, re-occurrence, and adverse events.</p> Results <p>Four cohort studies and 1 phase I-II trial were identified, including 117 patients with chronic and acute bacterial prostatitis. In 4 studies with chronic bacterial prostatitis, 72/99 (73%), 77/99 (78%), and 15/99 (15%) of patients had clinical cure, microbiological cure, and adverse events, respectively. In 1 study with acute bacterial prostatitis, 18/18 (100%), 11/12 (92%), and 2/18 (11%) of patients had clinical cure, microbiological cure, and adverse events, respectively. Also, 12 case reports were identified. In 5 cases with chronic bacterial prostatitis, 2/5 had both clinical and microbiological cures, and 1/5 had mild adverse events. In 8 patients with acute bacterial prostatitis, 8/8, 6/8, and 2/8 had clinical cure, microbiological cure, and adverse events, respectively.</p> Conclusion <p>Fosfomycin could be valuable in the treatment of patients with bacterial prostatitis when there are no other antibiotic options. Due to the limited available published clinical data, a more rigorous evaluation of its effectiveness and safety in this population is needed.</p>