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Fosfomycin
General information
Fosfomycin is a broad-spectrum antibiotic used to treat uncomplicated lower urinary tract infections. It penetrates interstitial space fluids of soft tissues well and reaches concentrations sufficient to substantially inhibit the growth of relevant bacteria at the target site [ ].
Fosfomycin has relatively low toxicity. Its penetration into tissues, including bones and joints, and into the cerebrospinal fluid is good. When given orally (2–3 g/day), it can produce gastrointestinal distress; when injected intramuscularly, it can cause local pain. Fosfomycin is recommended in daily doses of 4–16 g intravenously for the treatment of severe infections resistant to other commonly used antibiotics. Fosfomycin diffuses moderately well into bone tissue [ ].
During systemic administration, rises in the activities of serum transaminases and lactate dehydrogenase, skin reactions, eosinophilia, and altered vision have been noted [ ].
Drug studies
Comparative studies
In a multicenter trial in 749 ambulatory women aged at least 12 years with an acute uncomplicated urinary tract infection, a single dose of fosfomycin tromethamine 3 g had an equivalent bacteriological and clinical cure rate as a 7-day course of nitrofurantoin [ ]. Adverse events were reported by 5.3% of fosfomycin-treated patients (versus 5.6%). The most common adverse reactions were diarrhea (2.4%), vaginitis (1.8%), and nausea (0.8%), and 1.9% of fosfomycin-treated patients were withdrawn owing to adverse events (versus 4.3%).
Organs and systems
Nervous system
Fosfomycin concentrations in brain interstitium were measured in two patients after the intravenous administration of 4 g [ ]. Brain C max values were above the MICs for relevant pathogens, such as Streptococcus pneumoniae and Neisseria meningitidis . Variability in brain penetration might be explained by the degree to which the integrity of the blood–brain barrier is disrupted by the underlying disease.
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