Fosfomycin effective against multidrug-resistant E.coli related UTIs in selected patients

Spain: In a new study conducted by Jesus Sojo-Dorado it was found that because of a greater risk of adverse event-related discontinuations, fosfomycin did not show any noninferiority to the comparators as a targeted therapy of bUTI from multidrug-resistant (MDR) E coli. The findings of this study were published in the Journal of American Medical Association.

The emergence of multidrug-resistant Escherichia coli has resulted in an increase in the use of broad-spectrum medicines. It is vital to find alternatives for these illnesses, and certain neglected medications may be a solution. As a result, the goal of this study was to see if fosfomycin is non-inferior to meropenem or ceftriaxone in the treatment of bacteremic urinary tract infections (bUTIs) caused by MDR E coli.

From June 2014 to December 2018, 22 Spanish hospitals participated in this multicenter, pragmatic, randomized, open clinical study. Adult patients with bacteremic urinary tract infections caused by MDR E coli were eligible; 161 of 1578 screening patients were randomized and followed up for 60 days. The data was evaluated in May 2021. Patients were randomly assigned to receive either intravenous fosfomycin disodium at 4 g every 6 hours (70 participants) or a comparator (ceftriaxone or meropenem if resistant; 73 participants), with the choice to switch to oral fosfomycin trometamol for the fosfomycin group or an active oral drug or parenteral ertapenem for the comparator group after 4 days.

Results of this study state that:

1. In this modified intention-to-treat population of 143 patients, 48 of 70 patients (68.6%) treated with fosfomycin and 57 of 73 (78.1%) treated with comparators attained CMC.

2. While clinical or microbiological failure occurred in 10 patients (14.3%) treated with fosfomycin and 14 patients (19.7%) treated with comparators, fosfomycin had a higher risk of adverse event-related discontinuation.

3. In an exploratory examination of a group of 38 patients who completed rectal colonization trials, individuals treated with fosfomycin had a lower rate of acquiring new ceftriaxone-resistant or meropenem-resistant gram-negative bacteria than patients treated with comparators.

In conclusion, the statistics imply that the medicine is effective and should be investigated for certain individuals, notably those without a history of heart disease and who are at low risk of salt overload–related issues. There have been some questions expressed about the safety of fosfomycin. The possibility for reduced environmental effects of fosfomycin warrants further investigation.

Reference:

Sojo-Dorado J, López-Hernández I, Rosso-Fernandez C, et al. Effectiveness of Fosfomycin for the Treatment of Multidrug-Resistant Escherichia coli Bacteremic Urinary Tract Infections: A Randomized Clinical Trial. JAMA Netw Open. 2022;5(1):e2137277. doi:10.1001/jamanetworkopen.2021.37277

Keywords: bacteremia, urinary tract infections, fosfomycin, E.coli, multidrug-resistant, adverse effect, infection, inflammation, bacteria, microbes, antibiotics, UTIs, Jesús Sojo-Dorado