25
Sep
Despite the lack of data supporting its use we found that most patients receiving oral fosfomycin off-label for cUTI including pyelonephritis had clinical success. Bacterial resistance among uropathogens is on the rise and has led to a decreased effectiveness of oral therapies.
In the Hull and East Yorkshire area fosfomycin is a restricted antibiotic.
Fosfomycin for complicated uti. Fosfomycin tromethamine fosfomycin is indicated for uncomplicated urinary tract infections UTIs and displays in vitro activity against multidrug-resistant MDR isolates. However clinical data assessing fosfomycin for the treatment of complicated or MDR UTIs are limited. Oral fosfomycin use for pyelonephritis and complicated urinary tract infections.
A 1 year review of outcomes and prescribing habits in a large municipal healthcare system. Despite the lack of data supporting its use we found that most patients receiving oral fosfomycin off-label for cUTI including pyelonephritis had clinical success. There are few studies describing the off-label use of multiple-dose fosfomycin for outpatient treatment of complicated UTI.
To characterize the patients infections drug susceptibilities and outcomes of multiple-dose fosfomycin episodes investigators conducted a retrospective study evaluating patients with UTIs who received an outpatient prescription for multiple-dose fosfomycin between July 1999. Fosfomycin has been approved by the Food and Drug Administration FDA for the treatment of uncomplicated urinary tract infection UTI in adult women that is caused by Escherichia coli and Enterococcus faecalis2 Oral fosfomycin has also been used for non-FDA approved indication such as complicated UTI without bacteremia. According to the diagnosis criteria of Chinese Guidelines on Urological Infections patients 1870 years with acute uncomplicated cystitis recurrent lower urinary tract infection or complicated lower urinary tract infection received three doses of 3 g.
Fosfomycin has a broad spectrum of activity and often retains activity against multidrug-resistant gram-negative and gram-positive bacteria Infectious Disease News Editorial Board Member Keith. National guidelines have been published by two UK agencies NICE National Institute for Health and Care Excellence and PHE Public Health England. Fosfomycin is recommended for uncomplicated UTI defined as no feverflank pain caused by ESBL-producing E.
Coli in adults if the prescription is endorsed by a microbiologist 13 15. The Health Protection Agency HPA now recommends oral Fosfomycin as an alternative agent for treatment of community multi-resistant ESBL UTIs in both males and females with no feverflank pain where microbiological input has been obtained. Fosfomycin is an orally active bactericidal broad spectrum antibiotic that inhibits bacterial.
Fosfomycin Fomicyt InfectoPharm Germany reconstituted to 50000mgL was used in the bladder infection model and incorporated into solid media for susceptibility testing. SHU was used as a substitute for human urine. In two clinical studies oral treatment with fosfomycintrometamol was clinically eff ective against complicated or uncomplicated lower urinary tract infections caused by ESBL-producing E coli in cumulatively 75 938 of the 80 patients evaluated.
Initial clinical data support the use of fosfomycin. In the Hull and East Yorkshire area fosfomycin is a restricted antibiotic. Use should be reserved for the treatment of uncomplicated UTI due to Extended Spectrum Beta-Lactamase ESBLs producing Gram-negative bacteria ONLY when prescription is recommended by a Consultant Microbiologist or.
3 doses Remove urinary catheter whenever possible Nitrofurantoin and fosfomycin should be avoided if pyelonephritis is suspected Recommend urinalysis with urine culture before treatment Fluoroquinolones are no longer recommended as 1st-line agents due to high rates of E. Bacterial resistance among uropathogens is on the rise and has led to a decreased effectiveness of oral therapies. Fosfomycin tromethamine fosfomycin is indicated for uncomplicated urinary tract infections UTIs and displays in vitro activity against multidrug-resistant MDR isolates.
However clinical data assessing fosfomycin for the treatment of complicated or MDR UTIs are. Although not an FDA-approved indication fosfomycin is used to treat complicated UTIs excluding pyelonephritis perinephric abscess or UTI associated with bacteremia. It is important for providers to realize that the dosing of fosfomycin in these instances is different for complicated infections.
Urinary Tract Infection Acute Cystitis Acute cystitis caused by E. 3 g PO once. 2-3 g PO every 2-3 days for 3 doses.
Dissolve 1 packet 3 g in 3-4 oz water. Fosfomycin is a potential treatment option for patients with uncomplicated urinary tract infection due to resistant organisms. Nitrofurantoin may be more effective and can be used for urinary infections in pregnant women.
Among 47 patients with urinary tract infections UTIs due to multidrug-resistant MDR bacteria treatment with fosfomycin resulted in clinical cure rates of 87 and 94 at 48hours and 14days respectively. Response rates did not vary across pathogens.