Fosfomycin: A First-Line Oral Therapy for Acute Uncomplicated Cystitis

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dc.contributor.authorZhanel, George G.
dc.contributor.authorWalkty, Andrew J.
dc.contributor.authorKarlowsky, James A.
dc.date.accessioned2016-05-11T16:37:16Z
dc.date.available2016-05-11T16:37:16Z
dc.date.issued2016-5-10
dc.date.updated2016-05-11T14:05:14Z
dc.description.abstractFosfomycin is a new agent to Canada approved for the treatment of acute uncomplicated cystitis (AUC) in adult women infected with susceptible isolates of E. coli and Enterococcus faecalis. We reviewed the literature regarding the use of oral fosfomycin for the treatment of AUC. All English-language references from 1975 to October 2015 were reviewed. In Canada, fosfomycin tromethamine is manufactured as Monurol® and is available as a 3-gram single dose sachet. Fosfomycin has a unique chemical structure, inhibiting peptidoglycan synthesis at an earlier site compared to β-lactams with no cross-resistance with other agents. Fosfomycin displays broad-spectrum activity against ESBL-producing, AmpC-producing, carbapenem-non-susceptible, and multidrug-resistant (MDR) E. coli. Resistance to fosfomycin in E. coli is rare (ud_less_than1%). Fosfomycin is excreted unchanged in the urine by glomerular filtration with peak urinary concentration ~4000 µg/mL and remains at concentrations >100 µg/mL for 48 hours after a single 3-gram oral dose. No dosage adjustments are required in elderly patients, in pregnant patients, or in either renal or hepatic impairment. Fosfomycin demonstrates a favorable safety profile, and clinical trials have demonstrated efficacy in AUC that is comparable to ciprofloxacin, nitrofurantoin, and trimethoprim-sulfamethoxazole. Fosfomycin’s in vitro activity against common uropathogens, including MDR isolates, its favorable safety profile including pregnancy patients, drug interactions, and clinical trials data demonstrating efficacy in AUC, has resulted in Canadian, US, and European guidelines/authorities recommending fosfomycin as a first line agent for the treatment of AUC.
dc.description.versionPeer Reviewed
dc.identifier.citationGeorge G. Zhanel, Andrew J. Walkty, and James A. Karlowsky, “Fosfomycin: A First-Line Oral Therapy for Acute Uncomplicated Cystitis,” Canadian Journal of Infectious Diseases and Medical Microbiology, vol. 2016, Article ID 2082693, 10 pages, 2016. doi:10.1155/2016/2082693
dc.identifier.urihttp://dx.doi.org/10.1155/2016/2082693
dc.identifier.urihttp://hdl.handle.net/1993/31298
dc.language.rfc3066en
dc.rightsopen accessen_US
dc.rights.holderCopyright © 2016 George G. Zhanel et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
dc.titleFosfomycin: A First-Line Oral Therapy for Acute Uncomplicated Cystitis
dc.typeJournal Article
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