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Fosfomycin: Resurgence of an old companion

Sangeeta Sastry1, Yohei Doi1

  • 1Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Journal of Infection and Chemotherapy : Official Journal of the Japan Society of Chemotherapy
|March 1, 2016
PubMed

Insights

Fosfomycin shows renewed promise against multidrug-resistant (MDR) and extensively drug-resistant (XDR) pathogens due to its unique action. While effective for uncomplicated urinary tract infections (UTIs), emerging resistance may limit future applications.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Pharmacology

Background:

  • Fosfomycin, an antibiotic discovered decades ago, is experiencing a resurgence in interest.
  • Its activity against multidrug-resistant (MDR) and extensively drug-resistant (XDR) pathogens is notable.
  • Emerging plasmid-mediated resistance mechanisms pose a potential threat to its future efficacy.

Purpose of the Study:

  • To review the current knowledge on fosfomycin's efficacy and role in treating infections caused by resistant bacteria.
  • To highlight its unique mechanism of action and broad-spectrum activity.
  • To discuss its current approved uses, formulations, and safety profile.

Main Methods:

  • Review of in vitro data on fosfomycin activity against MDR/XDR organisms.
  • Analysis of available clinical outcome data for fosfomycin treatment.
  • Examination of fosfomycin's pharmacokinetic properties and drug interactions.

Main Results:

  • Fosfomycin demonstrates broad-spectrum activity, including against many Enterobacteriaceae like Escherichia coli.
  • In vitro studies show efficacy both as a single agent and in combination therapies against resistant pathogens.
  • Clinical outcomes are favorable for uncomplicated urinary tract infections (UTIs), but data for other conditions are limited.

Conclusions:

  • Fosfomycin remains a valuable agent with a favorable safety profile and minimal drug interactions.
  • Its unique mechanism and activity against resistant organisms warrant continued investigation for broader clinical applications.
  • Addressing emerging resistance is crucial to preserving fosfomycin's utility in the future antimicrobial armamentarium.
Keywords:
Clinical outcomeCombination therapyExtensive drug resistance (XDR)Multidrug resistance (MDR)PharmacokineticsSusceptibility testing

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