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1.
Expert Rev Anti Infect Ther ; 21(3): 281-293, 2023 03.
Article in English | MEDLINE | ID: mdl-36744387

ABSTRACT

INTRODUCTION: Methicillin-resistant and -susceptible Staphylococcus aureus (MRSA/MSSA) infections are a major global health-care problem. Bacteremia with S. aureus exhibits high rates of morbidity and mortality and can cause complicated infections such as infective endocarditis (IE). The emerging resistance profile of S. aureus is worrisome, and several international agencies have appealed for new treatment approaches to be developed. AREAS COVERED: Daptomycin presents a rapid bactericidal effect against MRSA and has been considered at least as effective as vancomycin in treating MRSA bacteremia. However, therapy failure is often related to deep-seated infections, e.g. endocarditis, with high bacterial inocula and daptomycin regimens <10 mg/kg/day. Current antibiotic options for treating invasive S. aureus infections have limitations in monotherapy. Daptomycin in combination with other antibiotics, e.g. fosfomycin, may be effective in improving clinical outcomes in patients with MRSA IE. EXPERT OPINION: Exploring therapeutic combinations has shown fosfomycin to have a unique mechanism of action and to be the most effective option in preventing the onset of resistance to and optimizing the efficacy of daptomycin, suggesting the synergistic combination of fosfomycin with daptomycin is a useful alternative treatment option for MSSA or MRSA IE.


Subject(s)
Bacteremia , Daptomycin , Endocarditis, Bacterial , Endocarditis , Fosfomycin , Methicillin-Resistant Staphylococcus aureus , Staphylococcal Infections , Humans , Daptomycin/pharmacology , Daptomycin/therapeutic use , Fosfomycin/adverse effects , Staphylococcus aureus , Anti-Bacterial Agents/therapeutic use , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/microbiology , Staphylococcal Infections/drug therapy , Staphylococcal Infections/microbiology , Endocarditis/drug therapy , Endocarditis/microbiology , Bacteremia/microbiology , Microbial Sensitivity Tests
2.
J Chemother ; 35(6): 471-476, 2023 Oct.
Article in English | MEDLINE | ID: mdl-36412538

ABSTRACT

The aim of the study was to evaluate clinical and microbiological efficacy and safety of intravenous fosfomycin for the treatment of carbapenem-resistant K. pneumoniae infections. All adult inpatients receiving 48 h of intravenous fosfomycin, alone or combined with other antibiotics were included in the study. Overall favorable clinical response rate was 75.3% among 94 patients. Clinical response rates were 92.3%, 72.2% and 56.0% for urinary tract infections, bacteremia and pneumonia, respectively. Microbiological eradication was achieved in 55 of 86 patients. 30-day mortality was 33.0%. Adverse events were generally mild. Common adverse events were hypokalemia (37.2%) and hypernatremia (22.3%). Intravenous fosfomycin is an effective antibiotic option with a good safety profile for the treatment of carbapenem-resistant K. pneumoniae infections. The most favorable clinical and microbiological responses are obtained in urinary tract infections. The efficacy of the drug in more severe infections, such as pneumonia and bacteremia, is comparable to the literature.


Subject(s)
Bacteremia , Carbapenem-Resistant Enterobacteriaceae , Fosfomycin , Klebsiella Infections , Pneumonia , Urinary Tract Infections , Adult , Humans , Fosfomycin/adverse effects , Klebsiella pneumoniae , Anti-Bacterial Agents/adverse effects , Carbapenems/adverse effects , Urinary Tract Infections/drug therapy , Urinary Tract Infections/microbiology , Bacteremia/microbiology , Pneumonia/chemically induced , Klebsiella Infections/microbiology , Microbial Sensitivity Tests
3.
Clin Infect Dis ; 75(2): 221-229, 2022 08 25.
Article in English | MEDLINE | ID: mdl-34791074

ABSTRACT

BACKGROUND: We aimed to determine the noninferiority of fosfomycin compared to ciprofloxacin as an oral step-down treatment for Escherichia coli febrile urinary tract infections (fUTIs) in women. METHODS: This was a double-blind, randomized, controlled trial in 15 Dutch hospitals. Adult women who were receiving 2-5 days of empirical intravenous antimicrobials for E. coli fUTI were assigned to step-down treatment with once-daily 3g fosfomycin or twice-daily 0.5g ciprofloxacin for 10 days of total antibiotic treatment. For the primary end point, clinical cure at days 6-10 post-end of treatment (PET), a noninferiority margin of 10% was chosen. The trial was registered on Trialregister.nl (NTR6449). RESULTS: After enrollment of 97 patients between 2017 and 2020, the trial ended prematurely because of the coronavirus disease 2019 pandemic. The primary end point was met in 36 of 48 patients (75.0%) assigned to fosfomycin and 30 of 46 patients (65.2%) assigned to ciprofloxacin (risk difference [RD], 9.6%; 95% confidence interval [CI]: -8.8% to 28.0%). In patients assigned to fosfomycin and ciprofloxacin, microbiological cure at days 6-10 PET occurred in 29 of 37 (78.4%) and 33 of 35 (94.3%; RD, -16.2%; 95% CI: -32.7 to -0.0%). Any gastrointestinal adverse event was reported in 25 of 48 (52.1%) and 14 of 46 (30.4%) patients (RD, 20.8%; 95% CI: 1.6% to 40.0%), respectively. CONCLUSIONS: Fosfomycin is noninferior to ciprofloxacin as oral step-down treatment for fUTI caused by E. coli in women. Fosfomycin use is associated with more gastrointestinal events. CLINICAL TRIAL REGISTRATION: Trial NL6275 (NTR6449).


Subject(s)
COVID-19 , Escherichia coli Infections , Fosfomycin , Urinary Tract Infections , Adult , Anti-Bacterial Agents/adverse effects , Ciprofloxacin/therapeutic use , Double-Blind Method , Escherichia coli , Escherichia coli Infections/complications , Escherichia coli Infections/drug therapy , Female , Fever/drug therapy , Fosfomycin/adverse effects , Humans , Urinary Tract Infections/microbiology
4.
Urologiia ; (6): 51-56, 2021 12.
Article in Russian | MEDLINE | ID: mdl-34967165

ABSTRACT

INTRODUCTION: Currently, empiric antibiotic therapy is considered the standard for acute cystitis. However, additional treatment may be required to alleviate the patient's condition and shorten the time to subjective recovery. AIM: To evaluate the efficiency of the combined administration of fosfomycin trometamol and herbal drug Canephron N in comparison with a single oral dose of fosfomycin trometamol in women with uncomplicated bacterial cystitis. MATERIALS AND METHODS: A randomized, comparative, open-label study was carried put between January 2018 and June 2019. The study included 112 women with symptoms of acute uncomplicated cystitis, who were randomized between two groups in a 1:1 ratio. In the main group, patients received a single oral dose of fosfomycin in combination with Canephron N (2 tablets t.i.d. for 2 weeks), while in the control group patients received only a single dose of fosfomycin (3 g). Symptoms were assessed using the Russian version of the Acute Cystitis Symptom Score (ACSS), completed daily for a week. Also, all patients underwent urine analysis on the 1st, 3rd, 5th and 7th days of therapy. The mean time to complete recovery based on the ACSS questionnaire and the time to resolution of pyuria were compared using the Mann-Whitney U test. Comparison of the proportion of patients with complete cure, according to the questionnaire, or with the elimination of pyuria was carried out using the chi-square test. RESULTS: The final analysis included 46 patients who received fosfomycin in combination with Canephron and 47 patients who received fosfomycin as monotherapy. In the group of combination therapy, patient-reported complete recovery (assessed by the ACSS questionnaire) was seen on average after 1 day, while in patients treated with monotherapy, the median time to subjective recovery was 3 days (p=0.00012). A significant difference between the groups in the proportion of patients with complete resolution of symptoms of acute cystitis was observed on days 1, 2, and 3 (p<0.05). The therapy was well tolerated in both groups. The most frequent adverse events were dyspepsia (8.7% in the combination group compared to 6.4% in the control group) and headache (in 4.3% and 6.4% of patients, respectively). CONCLUSION: the combined use of fosfomycin trometamol and the herbal drug Canephron N allows to reduce the duration of symptoms in patients with acute cystitis, thereby accelerating return to their usual lifestyle patterns.


Subject(s)
Cystitis , Fosfomycin , Urinary Tract Infections , Anti-Bacterial Agents/adverse effects , Cystitis/drug therapy , Female , Fosfomycin/adverse effects , Humans , Plant Extracts/adverse effects , Urinary Tract Infections/drug therapy
5.
J Infect Public Health ; 14(11): 1620-1622, 2021 Nov.
Article in English | MEDLINE | ID: mdl-34628083

ABSTRACT

We reviewed the efficacy and safety of intravenous (IV) fosfomycin for the treatment of infections caused by Gram-negative bacteria (GNB) with difficult-to-treat resistance (DTR). Data were retrospectively retrieved for all hospitalized patients who received IV fosfomycin for ≥48 h for the treatment of a DTR GNB between September 27, 2017 and January 31, 2020. A total of 30 patients were included, of which 63.3% were males, and the median age was 63.5 years (IQR 46-73). The median Charlson Comorbidity Score was 6 (IQR 3.8-9). The urinary tract (56.7%) was the most frequent site of infection, and the most frequent target organisms were Klebsiella pneumoniae (56.7%), and Escherichia coli (23.3%). The majority (76.%) received IV fosfomycin in combination with other antibacterial agents. Clinical improvement was observed in 22 (73.3%), eradication of baseline pathogens in 20 (66.7%), 30-day all-cause mortality in 7 (23.3%), and documented emergent resistance to fosfomycin in 5 (16.7%) patients. Treatment-related adverse events were infrequent and generally mild or moderate in severity. In conclusion, IV fosfomycin is a potentially efficacious and safe treatment option for the treatment of DTR GNB infections. Randomized trials are urgently required to confirm the utility of IV fosfomycin as monotherapy and in combination with other agents.


Subject(s)
Fosfomycin , Gram-Negative Bacterial Infections , Urinary Tract Infections , Anti-Bacterial Agents/adverse effects , Fosfomycin/adverse effects , Gram-Negative Bacterial Infections/drug therapy , Humans , Klebsiella pneumoniae , Male , Microbial Sensitivity Tests , Middle Aged , Retrospective Studies , Urinary Tract Infections/drug therapy
6.
Clin Microbiol Infect ; 27(10): 1441-1447, 2021 Oct.
Article in English | MEDLINE | ID: mdl-34111592

ABSTRACT

OBJECTIVE: We explored whether initial treatment with the herbal drug uva ursi (UU) reduces antibiotic use in women with uncomplicated urinary tract infection (UTI) without increasing symptom burden and complication frequency compared with antibiotic treatment. METHODS: A double-blind randomized controlled trial was conducted in 42 family practices in Germany. The participants were adult women with suspected uncomplicated UTIs receiving either UU 105 mg 3 × 2 tablets for 5 days (intervention) or fosfomycin a 3-g single dose (control), and their respective placebos. Participants and investigators were blinded. The primary outcome included (1) antibiotic courses day 0-28 as superiority, and (2) symptom burden (sum of daily symptom scores) day 0-7, as non-inferiority outcome (margin 125%). Clinicaltrials.gov: NCT03151603. RESULTS: Overall, 398 patients were randomly allocated to groups receiving UU (n = 207) and fosfomycin (n = 191). The number of antibiotic courses was 63.6% lower (95% CI 53.6%-71.4%; p < 0.0001) in the UU group than in the fosfomycin group. The ratio of total symptom burden in the UU group compared with control was 136.5% (95% CI 122.7-151.9; p 0.95), failing non-inferiority. Eight women developed pyelonephritis in the UU group compared with two in the fosfomycin group (mean difference 2.8; 95% CI 0.2-5.9; p 0.067). Adverse events were similar between the groups. DISCUSSION: In women with uncomplicated UTIs, initial treatment with UU reduced antibiotic use but led to a higher symptom burden and more safety concerns than fosfomycin.


Subject(s)
Arctostaphylos , Fosfomycin , Plant Extracts/therapeutic use , Urinary Tract Infections , Adult , Anti-Bacterial Agents/therapeutic use , Arctostaphylos/chemistry , Female , Fosfomycin/adverse effects , Fosfomycin/therapeutic use , Germany , Humans , Plant Extracts/adverse effects , Primary Health Care , Treatment Outcome , Urinary Tract Infections/drug therapy
7.
Indian J Med Microbiol ; 37(1): 95-98, 2019.
Article in English | MEDLINE | ID: mdl-31424016

ABSTRACT

There is a need of a relatively simple and inexpensive method for the determination of relative potency of various generic brands of antibiotics in comparison to original products. The current study describes an agar diffusion method which can be performed in any microbiology laboratory, is cheap (costs $2 per test) and its results can be available after overnight incubation. The results show that neither all generics are reliable nor are all generic antibiotics of poor quality.


Subject(s)
Anti-Bacterial Agents/pharmacology , Colistin/pharmacology , Drugs, Generic/pharmacology , Fosfomycin/pharmacology , Meropenem/pharmacology , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/pharmacokinetics , Bacteria/drug effects , Colistin/adverse effects , Colistin/pharmacokinetics , Drug Resistance, Multiple, Bacterial , Drugs, Generic/adverse effects , Drugs, Generic/pharmacokinetics , Fosfomycin/adverse effects , Fosfomycin/pharmacokinetics , Humans , Meropenem/adverse effects , Meropenem/pharmacokinetics , Microbial Sensitivity Tests , Therapeutic Equivalency
8.
Future Microbiol ; 14: 461-475, 2019 04.
Article in English | MEDLINE | ID: mdl-30854892

ABSTRACT

Fosfomycin is a bactericidal antibiotic available since the 1970s whose intravenous formulation has been available in many countries outside the USA. Given the rise in drug-resistant bacteria, its introduction into the US market has become a necessity for addressing these organisms. This review provides an overview of the microbiology, clinical pharmacology and initial clinical experiences of the intravenous fosfomycin product (ZTI-01) that is undergoing clinical development in the USA for the treatment of complicated urinary tract infections and acute pyelonephritis.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Fosfomycin/therapeutic use , Injections/methods , Urinary Tract Infections/drug therapy , Administration, Intravenous , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/pharmacology , Bacteria/drug effects , Bacterial Infections/drug therapy , Drug Combinations , Drug Resistance, Bacterial/drug effects , Fosfomycin/administration & dosage , Fosfomycin/adverse effects , Fosfomycin/pharmacology , Hospitalization , Humans , Microbial Sensitivity Tests , Pyelonephritis/drug therapy , Treatment Outcome , United States
9.
Pulm Pharmacol Ther ; 50: 82-87, 2018 06.
Article in English | MEDLINE | ID: mdl-29660401

ABSTRACT

BACKGROUND: The increased prevalence of multi-drug resistant strains of P.aeruginosa and allergic reactions among adult patients with cystic fibrosis (CF) limits the number of antibiotics available to treat pulmonary exacerbations. Fosfomycin, a unique broad spectrum bactericidal antibiotic, might offer an alternative therapeutic option in such cases. AIM: To describe the clinical efficacy, safety and tolerability of intravenous fosfomycin in combination with a second anti-pseudomonal antibiotic to treat pulmonary exacerbations in adult patients with CF. METHOD: A retrospective analysis of data captured prospectively, over a 2-years period, on the Unit electronic medical records for patients who received IV fosfomycin was performed. Baseline characteristics in the 12 months prior treatment, lung function, CRP, renal and liver function and electrolytes at start and end of treatment were retrieved. RESULTS: 54 patients received 128 courses of IV fosfomycin in combination with a second antibiotic, resulting in improved FEV1 (0.94 L vs 1.24 L, p < 0.01) and reduced CRP (65 mg/L vs 19.3 mg/L, p < 0.01). Renal function pre- and post-treatment remained stable. 4% (n = 5) of courses were complicated with AKI at mid treatment, which resolved at the end of the course. Electrolyte supplementation was required in 18% of cases for potassium and magnesium and 7% for phosphate. Nausea was the most common side effect (48%), but was well controlled with anti-emetics. CONCLUSION: Antibiotic regimens including fosfomycin appear to be clinically effective and safe. Fosfomycin should, therefore, be considered as an add-on therapy in patients who failed to respond to initial treatment and with multiple drug allergies.


Subject(s)
Anti-Bacterial Agents/administration & dosage , Cystic Fibrosis/drug therapy , Cystic Fibrosis/microbiology , Fosfomycin/administration & dosage , Pseudomonas Infections/drug therapy , Pseudomonas aeruginosa/drug effects , Administration, Intravenous , Adult , Anti-Bacterial Agents/adverse effects , C-Reactive Protein/metabolism , Creatinine/blood , Cystic Fibrosis/blood , Cystic Fibrosis/physiopathology , Drug Therapy, Combination , Female , Follow-Up Studies , Fosfomycin/adverse effects , Humans , Male , Retrospective Studies , Urea/blood
11.
Int J Antimicrob Agents ; 49(5): 542-548, 2017 May.
Article in English | MEDLINE | ID: mdl-28130072

ABSTRACT

Antimicrobial resistance is a major and emerging threat worldwide. New antimicrobials have been unable to meet the resistance challenge, and treatment options are limited for a growing number of resistant pathogens. More and more clinicians are relying on older antimicrobials for the treatment of multidrug-resistant (MDR) bacteria. Some older antimicrobials have maintained excellent in vitro activity against highly resistant pathogens. In some instances, use of older agents is limited by unfavourable pharmacokinetic/pharmacodynamic characteristics and/or toxicities. In general, clinical data pertaining to the use of older agents for the treatment of MDR pathogens are scarce. Research efforts should be focused on the evaluation of older agents for the treatment of MDR pathogens as well as evaluating how these agents perform in complex patient populations with various and multiple co-morbid conditions.


Subject(s)
Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/therapeutic use , Drug Resistance, Multiple, Bacterial , Gram-Negative Bacterial Infections/drug therapy , Gram-Positive Bacterial Infections/drug therapy , Aminoglycosides/adverse effects , Aminoglycosides/therapeutic use , Drug Combinations , Fosfomycin/adverse effects , Fosfomycin/therapeutic use , Gram-Negative Bacterial Infections/microbiology , Gram-Positive Bacterial Infections/microbiology , Humans , Microbial Sensitivity Tests , Minocycline/adverse effects , Minocycline/therapeutic use , Polymyxins/adverse effects , Polymyxins/therapeutic use , Sulfamethizole/adverse effects , Sulfamethizole/therapeutic use , Trimethoprim/adverse effects , Trimethoprim/therapeutic use , Trimethoprim, Sulfamethoxazole Drug Combination/adverse effects , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use
12.
Antimicrob Agents Chemother ; 58(9): 5598-601, 2014 Sep.
Article in English | MEDLINE | ID: mdl-24982065

ABSTRACT

Ninety-four patients infected with carbapenem-resistant Acinetobacter baumannii were randomized to receive colistin alone or colistin plus fosfomycin for 7 to 14 days. The patients who received combination therapy had a significantly more favorable microbiological response and a trend toward more favorable clinical outcomes and lower mortality than those who received colistin alone. (This study has been registered at ClinicalTrials.gov under registration no. NCT01297894.).


Subject(s)
Acinetobacter Infections/drug therapy , Acinetobacter baumannii/drug effects , Anti-Bacterial Agents/therapeutic use , Colistin/therapeutic use , Fosfomycin/therapeutic use , Acinetobacter Infections/microbiology , Acinetobacter Infections/mortality , Aged , Anti-Bacterial Agents/adverse effects , Carbapenems/therapeutic use , Colistin/adverse effects , Cross Infection/drug therapy , Cross Infection/microbiology , Drug Resistance, Multiple, Bacterial , Drug Therapy, Combination , Female , Fosfomycin/adverse effects , Humans , Male , Microbial Sensitivity Tests , Pilot Projects , Treatment Outcome
13.
Actas Urol Esp ; 38(6): 391-6, 2014.
Article in English, Spanish | MEDLINE | ID: mdl-24775812

ABSTRACT

OBJECTIVE: Prostate biopsy is the standardized diagnostic method for prostate cancer. However, although there is not a standardized protocol, there are recommendations in order to reduce the incidence of complications. The objective of the present work is to assess the efficacy and safety of antibiotic prophylaxis in the prostate biopsy by comparing two antibiotic regimes: two doses of fosfomycin-trometamol 3g (FMT) every 48 hours with 10 doses of oral ciprofloxacin 500 mg every 12 hours during 5 days. MATERIAL AND METHODS: Randomized prospective study was performed with 671 patients who had undergone to walking transrectal ultrasound guided prostate biopsy. Patients of group A (n=312) were treated with ciprofloxacin, and patients of group B (n=359) with FMT. Efficacy and tolerability of two prophylactic regimes were compared. Urine culture was carried out at 2 weeks after biopsy. Initially, patients with asymptomatic bacteriuria were not treated with antibiotics; urine culture was repeated after 1 month, persistent bacteriuria was treated according to antibiogram. RESULTS: No differences between groups were found in age (P=.78), cancer presence (P=.9) or number of biopsy cylinders (P=.93). The mean number of cores obtained was 11.3 ± 3.25 (range 6-20). Digestive intolerance was observed for 9 patients (2.9%) of group A and 10 patients (2.8%) in group B. One patient (.3%) of group A showed severe allergic reaction. In total, 167 patients (24.6%) had complications: 16 (2.4%) fever, 47 (6.9%) hemospermia, 81 (11.9%) hematuria, 7 (1%) rectal bleeding and 16 (2.4%) urinary retention. No statistically differences between groups were observed (27.6% vs. 22.6%; P=.17). However, hemospermia was more frequent in group A (9.9% vs. 4.5%; P=.006). Bacteriuria after biopsy was detected in 44 patients (6.6%), being more frequent in group B patients (4.2% vs. 8.6%; P=.02) although a higher number of second treatment cycles were not needed (53.9% vs. 29%; P=.17). The likelihood of resistance to ciprofloxacin in patients with bacteriuria in A was greater than that of FMT in B (69.2% vs. 41.9%; P=.0004). CONCLUSIONS: Antibiotic prophylaxis with FMT (2 doses of 3g) in prostate biopsy is an alternative as effective and safe as ciprofloxacin (10 doses of 500 mg), which carries lower rate of resistance. According to our experience, this drug is a safe, well-tolerated, and easily manageable prophylactic option, facilitating patient compliance. More prospective multicenter studies are necessary to confirm these findings.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Antibiotic Prophylaxis , Ciprofloxacin/therapeutic use , Fosfomycin/therapeutic use , Prostate/pathology , Prostatic Neoplasms/pathology , Aged , Aged, 80 and over , Anti-Bacterial Agents/adverse effects , Biopsy/methods , Ciprofloxacin/adverse effects , Fosfomycin/adverse effects , Humans , Male , Middle Aged , Prospective Studies , Rectum , Single-Blind Method , Treatment Outcome
14.
Drugs ; 73(17): 1951-66, 2013 Nov.
Article in English | MEDLINE | ID: mdl-24202878

ABSTRACT

Fosfomycin trometamol (fosfomycin tromethamine) [Monuril(®), Monurol(®), Monural(®)] is approved in numerous countries worldwide, mainly for the treatment of uncomplicated urinary tract infections (UTIs). Fosfomycin has good in vitro activity against common uropathogens, such as Escherichia coli (including extended-spectrum ß-lactamase-producing E. coli), Proteus mirabilis, Klebsiella pneumoniae and Staphylococcus saprophyticus, and the susceptibility of uropathogens to fosfomycin has remained relatively stable over time. A single oral dose of fosfomycin trometamol 3 g (the approved dosage) achieves high concentrations in urine. Results of recent randomized trials indicate that single-dose fosfomycin trometamol had similar clinical and/or bacteriological efficacy to 3- to 7-day regimens of ciprofloxacin, norfloxacin, cotrimoxazole or nitrofurantoin in women with uncomplicated lower UTIs. In addition, single-dose fosfomycin trometamol had similar bacteriological efficacy to a 5-day course of cefuroxime axetil or a 7-day course of amoxicillin/clavulanic acid in pregnant women with asymptomatic bacteriuria, and similar clinical and/or bacteriological efficacy to a 5-day course of cefuroxime axetil or amoxicillin/clavulanic acid or a 3-day course of ceftibuten in pregnant women with a lower UTI. Single-dose fosfomycin trometamol was generally well tolerated, with gastrointestinal adverse events (e.g. diarrhoea, nausea) reported most commonly. In conclusion, single-dose fosfomycin trometamol is an important option for the first-line empirical treatment of uncomplicated lower UTIs.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacteriuria/drug therapy , Fosfomycin/therapeutic use , Urinary Tract Infections/drug therapy , Acute Disease , Administration, Oral , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/adverse effects , Bacteriuria/microbiology , Drug Administration Schedule , Drug Resistance, Bacterial , Female , Fosfomycin/administration & dosage , Fosfomycin/adverse effects , Humans , Male , Microbial Sensitivity Tests , Pregnancy , Pregnancy Complications, Infectious/drug therapy , Pregnancy Complications, Infectious/microbiology , Urinary Tract Infections/microbiology
15.
Rev Esp Quimioter ; 26 Suppl 1: 1-84, 2013 01.
Article in Spanish | MEDLINE | ID: mdl-23824510

Subject(s)
Anti-Bacterial Agents/therapeutic use , Staphylococcal Infections/drug therapy , Staphylococcus aureus , Acetamides/adverse effects , Acetamides/pharmacokinetics , Acetamides/pharmacology , Acetamides/therapeutic use , Aminoglycosides/adverse effects , Aminoglycosides/pharmacokinetics , Aminoglycosides/pharmacology , Aminoglycosides/therapeutic use , Animals , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/pharmacokinetics , Anti-Bacterial Agents/pharmacology , Clindamycin/adverse effects , Clindamycin/pharmacokinetics , Clindamycin/pharmacology , Clindamycin/therapeutic use , Daptomycin/adverse effects , Daptomycin/pharmacokinetics , Daptomycin/pharmacology , Daptomycin/therapeutic use , Disease Models, Animal , Fluoroquinolones/adverse effects , Fluoroquinolones/pharmacokinetics , Fluoroquinolones/pharmacology , Fluoroquinolones/therapeutic use , Fosfomycin/adverse effects , Fosfomycin/pharmacokinetics , Fosfomycin/pharmacology , Fosfomycin/therapeutic use , Guidelines as Topic , Humans , Linezolid , Microbial Sensitivity Tests , Oxazolidinones/adverse effects , Oxazolidinones/pharmacokinetics , Oxazolidinones/pharmacology , Oxazolidinones/therapeutic use , Rifampin/adverse effects , Rifampin/pharmacokinetics , Rifampin/pharmacology , Rifampin/therapeutic use , Staphylococcal Infections/microbiology , Staphylococcus aureus/drug effects , Teicoplanin/adverse effects , Teicoplanin/pharmacokinetics , Teicoplanin/pharmacology , Teicoplanin/therapeutic use , Tetracyclines/adverse effects , Tetracyclines/pharmacokinetics , Tetracyclines/pharmacology
16.
Antimicrob Agents Chemother ; 56(8): 4511-5, 2012 Aug.
Article in English | MEDLINE | ID: mdl-22644033

ABSTRACT

We describe 3 patients with left-sided staphylococcal endocarditis (1 with methicillin-susceptible Staphylococcus aureus [MSSA] prosthetic aortic valve endocarditis and 2 with methicillin-resistant S. aureus [MRSA] native-valve endocarditis) who were successfully treated with high-dose intravenous daptomycin (10 mg/kg/day) plus fosfomycin (2 g every 6 h) for 6 weeks. This combination was tested in vitro against 7 MSSA, 5 MRSA, and 2 intermediately glycopeptide-resistant S. aureus isolates and proved to be synergistic against 11 (79%) strains and bactericidal against 8 (57%) strains. This combination deserves further clinical study.


Subject(s)
Anti-Bacterial Agents/administration & dosage , Daptomycin/administration & dosage , Endocarditis, Bacterial/drug therapy , Fosfomycin/administration & dosage , Methicillin-Resistant Staphylococcus aureus/drug effects , Staphylococcal Infections/drug therapy , Aged , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/therapeutic use , Daptomycin/adverse effects , Daptomycin/therapeutic use , Drug Synergism , Drug Therapy, Combination , Female , Fosfomycin/adverse effects , Fosfomycin/therapeutic use , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Staphylococcal Infections/microbiology
18.
Ter Arkh ; 84(12): 97-102, 2012.
Article in Russian | MEDLINE | ID: mdl-23479999

ABSTRACT

AIM: To study the clinical aspects of using the furasidine potassium in combination with basic magnesium carbonate (furamag) and phosphomycin trometamol (monural) as antimicrobial agents most frequently used in outpatient practice during combination therapy for acute and chronic urinary tract (UT) diseases. SUBJECTS AND METHODS: To study the specific features of therapy for UT infections, 60 patients were randomized to 2 groups: 1) 30 patients received a course therapy with furasidine potassium (furamag) in a dose of 50 mg t.i.d. for 7 days (a study group) and 2) 30 had phosphomycin trometamol (monural) in a single dose of 3 g for pulse therapy (a comparison group). The clinical efficacy of the drugs, symptom disappearance rates, bacterial changes, and laboratory and instrumental findings were assessed. The patient's opinion was mainly used to evaluate outpatient pharmacoeconomic efficiency. Patient compliance with the given therapy was estimated by taking into account the specific features of prehospital care. RESULTS: During therapy, both groups showed positive clinical changes. In the study group, the symptoms of dysuria resolved 0.5 days more quickly and a complete clinical remission was achieved 0.8 days more promptly; the latter within the first 72 hours was achieved by 7.5% more of the patients; the symptoms of bacteriuria resolved 0.6 days more rapidly. With the similar average price of the packs of furasidine potassium (furamag) 50 mg (30 capsules) and phosphomycin trometamol (monural) 1 g (a sachet) being 350 and 370 rubles, the average costs of required treatment were 482 and 546 rubles, respectively. No case of adverse reactions was recorded during the study. CONCLUSION: Patients with infectious and inflammatory diseases of UT should be given furasidine potassium in the standard dose of 50 mg t.i.d for 7 days.


Subject(s)
Anti-Infective Agents , Bacteria/drug effects , Fosfomycin , Reproductive Tract Infections , Urinary Tract Infections , Adult , Ambulatory Care/economics , Ambulatory Care/methods , Ambulatory Care/standards , Anti-Infective Agents/administration & dosage , Anti-Infective Agents/adverse effects , Anti-Infective Agents/economics , Attitude of Health Personnel , Bacteria/classification , Bacteria/isolation & purification , Bacteriological Techniques/methods , Drug Costs , Drug Therapy, Combination , Female , Fosfomycin/administration & dosage , Fosfomycin/adverse effects , Fosfomycin/economics , Fumarates/administration & dosage , Fumarates/adverse effects , Fumarates/economics , Humans , Male , Medication Adherence , Microbial Sensitivity Tests/methods , Outcome Assessment, Health Care , Reproductive Tract Infections/drug therapy , Reproductive Tract Infections/microbiology , Reproductive Tract Infections/physiopathology , Treatment Outcome , Urinary Tract Infections/drug therapy , Urinary Tract Infections/microbiology , Urinary Tract Infections/physiopathology , Urogenital System/microbiology , Urogenital System/physiopathology
19.
J Infect Chemother ; 17(1): 80-6, 2011 Feb.
Article in English | MEDLINE | ID: mdl-20694571

ABSTRACT

Fosfomycin calcium is a fosfomycin antimicrobial agent with a characteristic structure. After oral administration, the drug is absorbed and excreted via the kidneys in the unchanged form, without being metabolized in the body. It is, therefore, indicated for the treatment of urinary tract diseases, including cystitis and pyelonephritis. In the present study, the clinical usefulness of fosfomycin calcium (FOSMICIN® TABLETS 500) administered orally at the dosage of 1 g (two tablets) three times daily for 2 days was examined in female patients, who were at least 20 years of age, with acute uncomplicated cystitis of bacterial origin. Of the 48 patients enrolled between February 2008 and August 2008, 39 were evaluable for efficacy and safety. Overall evaluation of the cure revealed that microbiological eradication rate (microbiological outcome) and clinical efficacy rate (clinical outcome) at 5-9 days after drug administration (visit 2) were 94.9%. Determination of the microbiological and clinical outcomes for the evaluation of recurrence at 4-6 weeks after drug administration (visit 3) were 75.8 and 85.7%, respectively. Of the 48 patients, 40 (83.3%) returned to the clinic at visit 3. The causative bacterial species for cystitis was Escherichia coli in 31 (79.5%) of the 39 patients evaluable for efficacy and safety. Adverse drug reactions observed during the administration and follow-up periods included mild diarrhea and loose stools in 1 patient each, neither requiring any specific treatment. Evaluation of cure at visit 2 in patients in whom the causative bacterial species for the infection was E. coli revealed a microbiological outcome of 93.5%, and clinical outcome was 96.8%. Furthermore, evaluation for recurrence at visit 3 revealed a microbiological outcome of 74.1% and clinical outcome of 82.1%. When the patients were divided by age into an under 60 years of age group and an over 60 years of age group, the microbiological and clinical outcomes determined for evaluation of cure at visit 2 were 96.4 and 92.9%, respectively, and the corresponding rates determined for the evaluation of recurrence at visit 3 were 87.0 and 96.0%, respectively, in the under 60 years of age group. In the over 60 years of age group, the corresponding microbiological outcome and clinical outcome rates evaluated for cure were 90.9 and 100%, respectively, and those evaluated for recurrence were 50.0 and 60.0%, respectively. These results indicate the usefulness of fosfomycin calcium administered at 1 g three times daily for 2 days for acute uncomplicated cystitis.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Cystitis/drug therapy , Fosfomycin/therapeutic use , Urinary Tract Infections/drug therapy , Acute Disease , Adult , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/blood , Cystitis/blood , Cystitis/microbiology , Escherichia coli/drug effects , Escherichia coli/isolation & purification , Escherichia coli Infections/blood , Escherichia coli Infections/drug therapy , Escherichia coli Infections/microbiology , Female , Fosfomycin/adverse effects , Fosfomycin/blood , Humans , Microbial Sensitivity Tests , Middle Aged , Treatment Outcome , Urinary Tract Infections/blood , Urinary Tract Infections/microbiology
20.
Antimicrob Agents Chemother ; 49(9): 3749-54, 2005 Sep.
Article in English | MEDLINE | ID: mdl-16127049

ABSTRACT

Fosmidomycin is effective against malaria, but it needs to be given for > or =4 days when used alone. We conducted a study of 50 children with Plasmodium falciparum malaria to evaluate the safety and efficacy of consecutively shortened regimens of artesunate-fosmidomycin (1 to 2 mg/kg of body weight and 30 mg/kg of body weight, respectively; doses given every 12 hours). All dosing regimens were well tolerated. Artesunate-fosmidomycin acted rapidly, resulting in consolidated geometric mean parasite and fever clearance times of 24 h and 15 h, respectively. Treatment regimens of > or =2 days led to cure ratios of 100% by day 14 (39/39; 95% confidence interval [95% CI], 91% to 100%). Most importantly, the 3-day regimen achieved 100% cure on day 28 (10/10; 95% CI, 69% to 100%). Treatment with artesunate-fosmidomycin was associated with transient grade I or II neutropenia (absolute neutrophil counts of 750 to 1,200/microl and 400 to 749/microl, respectively) in six or two patients, respectively. Artesunate-fosmidomycin demonstrates the feasibility and potential value of short-course artemisinin-based combination chemotherapy with rapidly eliminated combination partners.


Subject(s)
Antimalarials/therapeutic use , Artemisinins/therapeutic use , Fosfomycin/analogs & derivatives , Malaria, Falciparum/drug therapy , Sesquiterpenes/therapeutic use , Antimalarials/adverse effects , Artemisinins/adverse effects , Artesunate , Chemistry, Pharmaceutical , Child , Cohort Studies , Dose-Response Relationship, Drug , Drug Combinations , Endpoint Determination , Female , Fosfomycin/adverse effects , Fosfomycin/therapeutic use , Humans , Malaria, Falciparum/blood , Malaria, Falciparum/parasitology , Male , Reverse Transcriptase Polymerase Chain Reaction , Sesquiterpenes/adverse effects
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