Fosfomycin: A Review

Abstract

FOSFOMYCIN WAS NOT mentioned as a therapeutic option for the treatment of urinary tract infections (UTIs) in the latest editions of two major textbooks of infectious diseases [1,2], despite the fact that it has been available in the United States for 4 years. It has been a commonly prescribed antibiotic in Japan and many parts of Europe for 2 decades. Fosfomycin was listed as a potentially useful antibiotic for the treatment of uncomplicated cystitis in an earlier review [3]. Currently, it has the approval of the U.S. Food and Drug Administration for the treatment of adult women with uncomplicated UTIs that are caused by Escherichia coli and Enterococcus faecalis. These introductory facts prompted this review of fosfomycin. We believe this discussion will be useful to practicing clinicians, especially those in the fields of internal medicine, gynecology, urology, and infectious diseases. Fosfomycin trometamol was first described in 1969 [4]. It is a phosphonic acid derivative, which acts primarily by interfering with bacterial peptidoglycan synthesis, thereby disrupting cell wall synthesis [5]. It has a broad spectrum of activity against aerobic bacteria, including those that cause UTIs [6]. There seems to be little cross-resistance between fosfomycin and other antibiotics commonly used to treat UTIs; thus, its efficacy is not affected by development of resistance to other antibiotics. It can be administered orally with a convenient dosing schedule, including single-dose therapy for uncomplicated cystitis.