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Fosfomycin combination therapy in high-risk paediatric patients with multidrug-resistant infections: a retrospective

Marco Denina1,2, Laura Badiali3,4, Raffaele Vitale3,5

  • 1Department of Pediatrics, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Turin, Italy. marco.denina@unito.it.

European Journal of Pediatrics
|April 10, 2026
PubMed

Insights

Intravenous fosfomycin combination therapy in children demonstrated good tolerability and acceptable outcomes for severe, difficult-to-treat infections, including those caused by multidrug-resistant bacteria.

Area of Science:

  • Infectious Diseases
  • Pediatric Pharmacology
  • Antimicrobial Resistance

Background:

  • Intravenous fosfomycin is a broad-spectrum antibiotic effective against Gram-positive and Gram-negative bacteria, including multidrug-resistant (MDR) strains.
  • Limited evidence exists on its use in pediatric patients, especially in combination therapy.
  • This study addresses the need for data on IV fosfomycin in vulnerable pediatric populations.

Purpose of the Study:

  • To evaluate the safety and clinical outcomes of intravenous fosfomycin-based combination therapy in pediatric patients.
  • To assess the efficacy of this regimen in treating severe and complex infections in children.
  • To determine the tolerability profile of IV fosfomycin in a pediatric cohort.

Main Methods:

  • Retrospective, single-center study of pediatric patients (0-18 years) receiving IV fosfomycin.
  • Inclusion of patients with comorbidities, immunosuppression, invasive devices, or prematurity.
  • Analysis of safety, clinical outcomes, and microbiological data for infections treated with fosfomycin combination therapy.

Main Results:

  • Fifty pediatric patients were included, with 80% having comorbidities and 56% immunodeficiency.
  • Fosfomycin was used for bloodstream, osteoarticular, and other severe infections, often involving MDR pathogens.
  • Therapeutic failure occurred in 28% of cases; IV fosfomycin was well tolerated with no treatment discontinuations due to adverse effects.

Conclusions:

  • IV fosfomycin-based combination therapy is well-tolerated in vulnerable pediatric patients with severe conditions.
  • It offers acceptable clinical outcomes for difficult-to-treat infections, including those with MDR bacteria.
  • Consider IV fosfomycin as a valuable rescue therapy for infections resistant to standard treatments.
Keywords:
Antimicrobial stewardshipCombination therapyIntravenous fosfomycinMultidrug-resistant infectionsPaediatric high-risk patientsSafety profi le

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