New Horizons for the Role of Fosfomycin in the Era of Multi-drug Resistant Urinary Tract Infections

Abstract

The genital-urinary system is a complex of organs which are anatomically and physiologically interconnected. Therefore, infectious diseases of the urinary tract can affect the urethra, bladder and urethra, kidneys and prostate gland. Urinary tract infections (UTIs) are characterized by the presence of bacteria, viruses, fungi or parasites in the urinary tract, which cause inflammation and form the clinical picture of the disease. Despite the fact that fosfomycin is an antibiotic with a long history, it has unique properties that make it an effective antibiotic therapy for UTIs with consistently low resistance patterns of uropathogens. It is an antibacterial drug with a chemical structure that is not similar to other known antibiotics and is considered a strong alternative in the treatment of infections caused by multi-resistant pathogens, has a wide spectrum of action against gram-positive and gram-negative microorganisms, including many antibiotic-resistant microorganisms. Current data indicate the ability to penetrate biofilms of uropathogens, synergistically enhance the transport of other antibiotics inside bacterial cells, as well as a significant reduction in the virulence of pathogens when fosfomycin resistance is acquired. Fosfomycin has such advantages as a high concentration in the urinary tract, a minimal effect on the gastrointestinal flora and a practical lack of tendency to form resistance. Today, the safety and effectiveness of the drug has been proven as a means of antibiotic prophylaxis after operations on the lower urinary tract, transrectal biopsy of the prostate gland and frequently recurrent UTIs, in the treatment of asymptomatic bacteriuria and UTIs during pregnancy, in the treatment of chronic bacterial prostatitis, as well as a part of antimicrobial measures in multiresistant bacterial strains.