Fosfomycin trometamol in a single dose versus seven days nitrofurantoin in the treatment of acute uncomplicated urinary tract infections in women

Abstract

In general practice acute uncomplicated urinary tract infections in women are treated with different courses of antibiotics. In this study the efficacy and tolerability of a single dose of 3 g fosfomycin trometamol and the conventional treatment with nitrofurantoin 50 mg four times daily for seven days were compared. In a randomized, double-blind, double-dummy trial in 31 general practices in the Netherlands 231 patients with symptoms of acute dysuria, stranguria and/or urinary frequency received treatment. Evaluation was based on resolution of symptoms, dipslide results and side-effects at 4, 9 and 42 days after starting the treatment. The clinical cure rates and bacteriological cure rates were not significantly different between the treatment groups. Side-effects were reported at day 4 by 43% of the women receiving single-dose treatment, compared with 25% of the women in the seven-day treatment group, a significant difference. At day 9 the groups did not significantly differ in the number of patients with side-effects. Almost all side-effects were mild and gastro-intestinal complaints were reported most. Taking into account the convenience of taking a single dose we conclude that fosfomycin trometamol is a reasonable alternative to 7 days nitrofurantoin 50 mg four times a day in the treatment of women with symptoms of acute uncomplicated urinary tract infections in general practice.

Fosfomycin in the treatment of extended spectrum beta-lactamase-producing Escherichia coli-related lower urinary tract infections

“…Relapse and reinfection rates were 0% and 10.7%, respectively. These rates are in concordance with the relapse rates in published trials with one dose of 3 g FT [17,18].…”

“…A single dose of FT had activity comparable with a 5-day course of TMP in a trial where the causative organism and its sensitivity were unknown. In another trial FT showed better long-term eradication compared with a 5-day course of cephalexin, and other studies suggested a single dose of FT was comparable with a 7-day course of nitrofurantoin or norfloxacin [15][16][17][18]. In our study, FT was initiated empirically in all patients in our outpatient clinic or during consultations of hospitalized patients.…”

Clinical significance of the pharmacokinetic and pharmacodynamic characteristics of fosfomycin for the treatment of patients with systemic infections

“…Fosfomycin therapy has not been found to be inferior in terms of clinical or microbiological effectiveness to 7-day pipemidic acid [45,46], 5-day amoxicillin/clavulanic acid [47]. 5-day trimethoprim/sulfamethoxazole [48], 7-day norfloxacin [49,50], 5-day cefalexin [51] or 7-day nitrofurantoin therapy [52].…”

Fosfomycin and Its Application in the Treatment of Multidrug-Resistant Enterobacteriaceae Infections

“…A single 3 g dose of fosfomycin was compared with single doses of amoxicillin 3 g, 188,189 ofloxacin 200 mg, 190 norfloxacin 800 mg, 191 pefloxacin 800 mg, 192 trimethoprim 200 mg, 193 and cotrimoxazole 1920 mg. 190 A single dose of fosfomycin was also compared with amoxicillin + clavulanic acid 375 mg four times daily for five days, 194 cefalexin 500 mg four times daily for five days, 195 ciprofloxacin 500 mg twice daily for five days, 196 pipemidic acid 400 mg twice daily for 5-7 days, [197][198][199] norfloxacin 400 mg bid for 5-7 days, 197,[200][201][202][203] cotrimoxazole 480 mg twice daily for three days, 204 trimethoprim 200 mg twice daily for five days, 18 and nitrofurantoin 50 mg four times daily for seven days. 205 In these studies, the microbiological and clinical efficacies were similar, and 70%-95% microbial eradication rates were observed 5-11 days after treatment.…”