Clinical Efficacy of Fosfomycin for the Treatment of Complicated Lower Tract and Uncomplicated Urinary Tract Infections
Keywords:UTI, Fosfomycin, VRE, ESBL.
Fosfomycin is an oral antibiotic with activity against multidrug resistant organisms, including vancomycin-resistant enterococcus (VRE)Â and extended-spectrum Î²-lactamase (ESBL) producing Enterobacteriaceae. However, there is currently no information describing effiacy ofÂ fosfomycin compared to other agents for healthcare associated UTIs.Â Additionally, there is minimal information characterizing the potentialÂ cost savings with utilization of fosfomcyin versus traditional therapies.Â This retrospective study evaluated clinical and economic outcomes ofÂ fosfomycin compared to matched controls. The controls were beforeÂ the addition of fosfomycin to hospital formulary with recommendedÂ prescribing criteria. The fosfomycin group consisted of patients whoÂ were admitted to the hospital after the addition of fosfomycin to theÂ hospital formulary with recommended prescribing criteria. PatientsÂ receiving fosfomycin for the treatment of UTI were matched to control patients based on pathogen, renal function, and presence of aÂ lower UTI. A total of 86 patients were evaluated. The majority ofÂ patients received fosfomycin for the treatment of VRE (45.6%) andÂ ESBL producing Enterbacteriaceae (16.3%) UTIs. Patients with a combination of allergies or documented resistance to fist line agents also
received fosfomycin to treat Enterococcus (25.6%), EnterobacteriaceaeÂ (7.8%), or polymicrobial UTIs (4.7%). Doxycycline, nitrofurantoin, sulfamethoxazole/trimethoprim, meropenem, and linezolid were the mostÂ common antibiotics prescribed in the control group. The average days
of treatment were lower in the fosfomycin group (2.93 vs. 7.19 days,Â p<0.0001). Fosfomcyin was associated with similar clinical success rates (95 vs. 95%, p>0.99) and recurrence rates (4.7 vs. 4.7%, p>0.99).Additionally, the mean antibiotic cost per patient was lower in theÂ fosfomycin group ($106.74 vs. $269.55). Adding fosfomycin to formulary resulted in similar clinical success rates and lower cost for theÂ treatment of complicated lower and uncomplicated UTIs.
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