Fosfomycin

Abstract

SUMMARYThe treatment of bacterial infections suffers from two major problems: spread of multidrug-resistant (MDR) or extensively drug-resistant (XDR) pathogens and lack of development of new antibiotics active against such MDR and XDR bacteria. As a result, physicians have turned to older antibiotics, such as polymyxins, tetracyclines, and aminoglycosides. Lately, due to development of resistance to these agents, fosfomycin has gained attention, as it has remained active against both Gram-positive and Gram-negative MDR and XDR bacteria. New data of higher quality have become available, and several issues were clarified further. In this review, we summarize the available fosfomycin data regarding pharmacokinetic and pharmacodynamic properties, thein vitroactivity against susceptible and antibiotic-resistant bacteria, mechanisms of resistance and development of resistance during treatment, synergy and antagonism with other antibiotics, clinical effectiveness, and adverse events. Issues that need to be studied further are also discussed.

Pharmacodynamic Evaluation of Fosfomycin against Escherichia coli and Klebsiella spp. from Urinary Tract Infections and the Influence of pH on Fosfomycin Activities

“…However, this drug was less active against Klebsiella spp., which displayed a higher MIC distribution (21)(22)(23). Falagas et al reported that the fosfomycin MIC distribution can be quite variable and can also be influenced by several factors, including bacterial species (24). A retrospective study from a hospital in Oxfordshire, UK, found the rate of fosfomycin resistance to be 1% for E. coli isolates but 19% for Klebsiella isolates when oral fosfomycin was used to treat UTIs (25).…”

Fosfomycin: Mechanism and Resistance

“…Initial data supported use of fosfomycin for treatment of UTIs caused by MDR Enterobacteriaceae, including those carrying ESBLs (Falagas et al 2010a). Resistance data from studies after 2010 (Falagas et al 2016) was mostly on pathogens from urine samples and showed that E. coli susceptibility ranged from 82% to 100% and K. pneumoniae from 15% to 100%. There was less data on other Enterobacteriaceae, but fosfomycin was active against 72% to 97.5%.…”

Prevalence of Fosfomycin Resistance in Methicillin-Resistant <i>Staphylococcus aureus</i> Isolated from Patients in a University Hospital in China from 2013 to 2015

“…Under such circumstances, fosfomycin has gained attention recently as it has potential synergistic activity with other agents against multidrug-resistant or extensively drug resistant bacteria including MRSA (3,11,12).Several findings have reported that fosfomycin achieves high concentrations in skin and soft tissues (13,14).Since increased CA-MRSA infections have been reported in China, mainly SSTI caused by ST59 MRSA, fosfomycin might become important alternative treatment for SSTI(15).…”