Fosfomycin as a promising alternative to treat urinary tract infection due to multidrug resistant uropathogens (original) (raw)
Related papers
Drug Review: Fosfomycin—A Rarely used but more Practical Approach for Urinary Tract Infections
Journal of SAFOG, 2015
In this current era of resistance, treating urinary tract infections (UTIs) on outpatient department (OPD) basis has become cumbersome. Resistance has dramatically increased for cotrimoxazole, levofloxacin, ciprofloxacin and nitrofurantoin in past few decades. Intravenous drugs increase the cost of treatment and patient may need hospitalization. We searched and analyzed the literature and found fosfomycin to be better alternative in resistant UTI as resistance to this drug is low and is cost-effective in comparison to available intravenous drugs.
IP Innovative Publication Pvt. Ltd., 2019
Introduction: Urinary tract infection (UTI) is an important cause of illness in humans with emergence of multidrug resistance. Fosfomycin remains to be effective against MDR uropathogens. We evaluated susceptibility of Fosfomycin against uropathoges. Materials and Methods: A prospective study was conducted for a period of 6 months in a tertiary care hospital MIMS, Mandya. Significant bacterial growth were identified in urine samples and processed accordingly. Fosfomycin susceptibility was performed by Kirby-Bauer disc diffusion method along with other drugs advised as per CLSI guidelines. Results: A total of 893 urine samples were received, 150 samples showed significant growth of one or two organisms, yielding a sum of 162 isolates. Out of 162 isolates with significant growth of organisms, majority were Gram negative bacilli (GNB) accounting for 63.6% (103 isolates) followed by Gram positive cocci (GPC) 36.4% (59 isolates). Out of 103 GNB, ESBL producer were 25.2%, Carbapenamase producer were 1.9%, Amp C were 6.8%, ESBL+ Carbapenamase were 4.9%, Amp C + Carbapenemase were 2.9% and 58.3% were non ESBL, Carbapenamase and AmpC producer. Out of 162 isolates, 156(96.3 %) were sensitive to Fosfomycin and 6 (3.7%) were resistant to Fosfomycin. Conclusions: Fosfomycin is effective against MDR, ESBL, AmpC and Carbapenamse producing uropthaogens. It is an effective, convenient and safe drug for treating the patients of all age group and pregnant mothers with uncomplicated UTIs. Keywords: UTI, MDR, AmpC, ESBL, GPC, GNB.
Antibiotics
Fosfomycin represents a relatively old antibiotic, but it is experiencing a comeback in recent years. According to some studies, the increasing therapeutic use of this drug led to a rapid increase in the levels of resistance in bacteria causing urinary tract infection. In the presented study, levels of resistance to fosfomycin in more than 3500 bacterial isolates before and after fosfomycin introduction into therapeutic use in the Czech Republic and the clinical efficacy of treatment in 300 patients using this drug were assessed. The results show that the resistance levels to fosfomycin in Escherichia coli isolates before and after the drug registration were not significantly different (3.4% and 4.4%, respectively). In some other Gram-negative rods, such as otherwise susceptible Enterobacter, resistance to fosfomycin increased significantly from 45.6% to 76.6%. Fosfomycin treatment of urinary tract infections showed an excellent seven-day clinical efficacy (79.7%). However, when use...
2022
Urinary tract infections are one of the most common bacterial infections causing high morbidity and mortality. Alarming rise of multidrug resistant uropathogens worldwide, forced the clinician to rethink about the old drugs like Fosfomycin for its therapeutic management. Our objective was to compare agar dilution (AD), disc diffusion (DD) and E test method for antimicrobial susceptibility testing (AST) of Fosfomycin against different drug resistant uropathogens. Consecutive 181 uropathogens were tested for Fosphomycin AST using AD, DD and E test. Results were interpreted using Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints. Escherichia coli was found as the most common (62.4%) uropathogen followed by Klebsiella spp. (21%). Considering agar dilution as gold standard, 6.1% of isolates were resistant to Fosfomycin. Following CLSI breakpoints, the susceptibility of E.coli, Klebsiella spp., other Ente...
Overview on fosfomycin and its current and future clinical significance
Current Issues in Pharmacy and Medical Sciences
Fosfomycin is an old antibiotic with a unique chemical structure and with broadspectrum activity against numerous bacterial pathogens, both Gram-positive and Gramnegative, including resistant and multi-resistant strains. This antibiotic was accepted into clinical practice in the early 1970s. Its use, however, has been limited for several years for treating mainly lower uncomplicated urinary tract infections (in the form of fosfomycin trometamol taken orally). Nowadays, many clinicians and scientists are looking at this antibacterial drug for its employment in the treatment of severe infections caused by multi-resistant bacteria. Fosfomycin as an intravenous formulation (fosfomycin disodium) achieves clinically relevant concentrations in the serum and the cerebrospinal fluid, in kidney, bladder wall, prostate, lungs, bone and heart valves tissues, as well as in inflamed tissues and abscess fluid. The available clinical studies confirmed the efficacy of intravenous fosfomycin for the ...
Asian Journal of Pharmaceutical and Clinical Research, 2021
Objectives: Urinary tract infection (UTI) affects 150 million people worldwide each year. The rise in the UTIs is attributed to multidrug-resistant pathogens for which there are minimal treatment options available. This has facilitated the reemergence of certain old antimicrobials such as fosfomycin trometamol (FT). It seems an alternative, but the evidence towards its therapeutic efficiency is scanty. The objective of the study is to evaluate the safety and efficacy of single dose of FT in treating uncomplicated UTI and the resultant variations in the intensity of symptoms after the treatment. Methods: The study is a prospective, observational, and open-label study in the outpatient unit of the Department of General Medicine, RVM institute of Medical Sciences, for 6 months. The study comprises 50 patients among the age group of 18-70 years. Urinary Tract Infection Symptom Assessment questionnaire was used for the evaluation of symptoms pre and post treatment. After the diagnosis of uncomplicated UTI, patients were treated with single-dose of FT. Results: The study comprises 22 males and 28 females. After the treatment, there was a drastic improvement in the condition of patients. The severity level reduced and the quality of life improved post treatment and the results were statistically significant. Among 50 patients treated with the drug, 11 patients reported the side effect of diarrhea. Conclusion: Single dose oral Fosfomycin (3 g) regimen is effective in managing uncomplicated UTI with minimal side effects.
Fosfomycin; A Better Choice Against Bacteria Causing Urinary Tract Infections
2018
Background and Objective: Foot ulceration and amputation cause extensive burden on individuals and health care system. Due to multi-factorial pathology of diabetic foot ulceration the person with diabetes should receive health education which is tailored to the individual's risk status, promote self-care and address misconception. Diabetic patients are at high risk of developing complications. One of major complication is foot ulcer which may lead to amputation. This can be prevented up to some extent by accurate interpretation of medical information regarding ulcer causes and risk factors. So we are conducting this research to access the “Knowledge and Practices Regarding Foot Care in Diabetic Patient” and will make some recommendations to prevent foot ulcer. Material and Methods: A cross-sectional study was carried out over a period of 3 months from 1st April to 30th of June 2014 at OPD & Indoor of various public sector hospitals of Lahore” (Services hospital, Mayo hospital, L...
Fosfomycin: Pharmacological, Clinical and Future Perspectives
Antibiotics
Fosfomycin is a bactericidal, low-molecular weight, broad-spectrum antibiotic, with putative activity against several bacteria, including multidrug-resistant Gram-negative bacteria, by irreversibly inhibiting an early stage in cell wall synthesis. Evidence suggests that fosfomycin has a synergistic effect when used in combination with other antimicrobial agents that act via a different mechanism of action, thereby allowing for reduced dosages and lower toxicity. Fosfomycin does not bind to plasma proteins and is cleared via the kidneys. Due to its extensive tissue penetration, fosfomycin may be indicated for infections of the CNS, soft tissues, bone, lungs, and abscesses. The oral bioavailability of fosfomycin tromethamine is <50%; therefore, oral administration of fosfomycin tromethamine is approved only as a 3-gram one-time dose for treating urinary tract infections. However, based on published PK parameters, PK/PD simulations have been performed for several multiple-dose regimens, which might lead to the future use of fosfomycin for treating complicated infections with multidrug-resistant bacteria. Because essential pharmacological information and knowledge regarding mechanisms of resistance are currently limited and/or controversial, further studies are urgently needed, and fosfomycin monotherapy should be avoided.
Journal of Pre-Clinical and Clinical Research, 2015
The problem of significantly reduced drug use concerns particularly the infections caused by multi-resistant pathogens, especially Gram-negative bacteria. In this regard, interest is increasing in the known for nearly 50 years, but now frequently forgotten antibiotic-fosfomycin. Fosfomycin possesses high effectiveness for multidrug-resistant bacteria, comprising of extended-spectrum β-lactamases (ESBL), Klebsiella pneumoniae carbapenemases (KPC); commonly, the pandrug-resistant (PDR) and the extensively drug-resistant (XDR) strains, especially from Enterobacteriaceae family. Because of facilitated distribution into inflamed tissues and a very broad range of in vitro bactericidal activity, fosfomycin may have various applications in the treatment of many kinds of bacterial infections, including acute uncomplicated infections of the urinary bladder or complicated urinary tract infections, urinary tract sepsis, pyelonephritis, cystitis, prostatitis and chronic lung infections in patients with cystic fibrosis, the great majority caused by multi-resistant Gram-negative bacteria, and in the therapy eradicating multidrug-resistant Helicobacter pylori. Fosfomycin may limit the toxicity of other antibiotics and play a protective role in the process of bacterial resistance development during the therapy. Combinations of different antimicrobials enable the use of forgotten antibiotics in commonly occurring infections, although they are still completely incurable.
Fosfomycin and Its Application in the Treatment of Multidrug-Resistant Enterobacteriaceae Infections
Clinical Medicine Reviews in Therapeutics, 2011
The use of fosfomycin has been limited in therapeutics in recent years. Because it has shown good antibacterial activity in vitro and clinical efficacy in some domains, it has been proposed as an alternative to current antimicrobial agents, which are subject to increasing resistance. This paper reviews the main properties of fosfomycin and the latest publications concerning multidrugresistant Enterobacteriaceae infections. In uncomplicated urinary tract infections, a single oral dose was found to be safe and effective. In complicated urinary tract infections, the same results were observed with several doses. In both cases, by using fosfomycin to treat infections, the use of carbapenems could be reduced, leading to lower costs and better microbial ecology. In severe infections, combinations with intravenous fosfomycin need to be explored further because its future activity may depend on choosing a good partner drug. Because of the fast evolution of microbial resistance, more studies are urgently needed.