Efficacy of Single Dose of Fosfomycin Versus a Five-Day Course of Ciprofloxacin in Patients With Uncomplicated Urinary Tract Infection

Abstract

Introduction and objective: Treatment has become more challenging due to an aging population, polypharmacy and high prevalence of comorbid illness, antimicrobial antibiotic allergy or sensitivity, an increase in the number of individuals with underlying immunological or structural abnormalities, as well as the frequency of multidrug-resistant infections. Many multidrug-resistant bacteria are still susceptible to nitrofurantoin and fosfomycin, two ancient medicines. Their high urine concentrations and low toxicity give them an advantage over newer medications. This study aimed to compare the efficacy of a single dose of fosfomycin versus a five-day course of ciprofloxacin in patients with uncomplicated urinary tract infections. Methodology and data collection procedure: This randomized control trial was conducted in the Department of Medicine, Benazir Bhutto Hospital, Rawalpindi. A total of 46 patients were enrolled. Patients were divided randomly into two groups by using the lottery method. In group A, patients were given a single 3 g dose of oral fosfomycin. In group B, patients were given oral ciprofloxacin (500 mg) daily for five days. Then patients were followed-up in the Outpatient Department (OPD) for 28 days. After 28 days, patients were evaluated for resolution of symptoms (as per operational definition). Patients in whom symptoms would not be resolved were managed as per standard protocol. All this information was recorded on proforma. Results: The average age of the patients in group A was 39.41±9.80 years while in group B that was 41.32±17.76 years. In both groups, 23 females were equally divided. The mean duration of symptoms in group A was 4.78±1.98 days while in group B was 4.95±1.29 days. The minimum duration of symptoms was three days and the maximum was 10 days. In group A, there were 15 (65.21%) patients with efficacy achieved, and among eight (34.78%) patients, efficacy was not achieved while in group B, there were 15 (65.21%) patients in which efficacy was achieved, and among eight (34.78%) patients, efficacy was not achieved. There was no significant association between efficacy and study groups as the p-value was not significant (p=0.87). Conclusion: The conclusion of the study was that in the treatment of simple urinary infections, a single dose of fosfomycin had equal efficacy and tolerability as a five-day course of ciprofloxacin.

Antimicrobial Susceptibilities of Clinical Bacterial Isolates from Urinary Tract Infections to Fosfomycin and Comparator Antibiotics Determined by Agar Dilution Method and Automated Micro Broth Dilution

“…In our study, with the exception of one isolate, all fosfomycin-resistant E. coli were susceptible to either all or at least one of the comparator UTIs first-line or alternate drugs. Clinical studies have compared the efficacy of fosfomycin to comparator UTI first-line drugs and have shown it to be a valuable alternative option (24,42,(44)(45)(46)(47). In a study investigating treatment patterns and clinical outcomes among females with uncomplicated bUTI in Germany that were empirically treated, the incidence of recurrent infection in the 6-month post-index period was higher in patients with E. coli that were resistant to one of the first-line treatments (48).…”

Multi-Drug Resistant Escherichia Coli and Their Sensitivity to Oral Fosfomycin in Urinary Tract Infections: A Single-Center Experience

“…In pregnant women with a urinary tract infection, the majority of multidrug-resistant patients and extended beta lactamase-generating organisms were found to be susceptible to fosfomycin 13 . In a different study that examined the sensitivity of fosfomycin in MDR cases and extended-spectrum beta-lactamase-producing organisms (ESBL); a single dosage of fosfomycin (3 gm) was shown to be equally efficacious for treating uncomplicated urinary tract infections as ciprofloxacin 500 mg for five days according to a randomized controlled trial that involved 260 individuals 14 . In vitro sensitivity of common pathogens of urinary tract infections to fosfomycin was evaluated by Anand et al in 2019 and it was discovered that the bacteria were extremely susceptible to fosfomycin 15 .…”