Oral treatment of urinary tract infection: Could the answer lie in a sachet?

Abstract

Introduction: Fosfomycin trometamol is a phosphonic acid derivative, which acts primarily by interfering with bacterial peptidoglycan synthesis with broad spectrum of activity against agents causing urinary tract infections (UTIs) with good antibiofilm activity and limited reports of resistance. There are limited studies from India regarding the efficacy of the drug, so the study was conducted to determine the in vitro efficacy of fosfomycin. Materials and Methods: Two hundred and thirty nonrepetitive urinary isolates over a period of 4 months were included in the study. Antibiotic susceptibility and extended-spectrum β-lactamase (ESBL) detection following the Clinical and Laboratory Standards Institute guidelines were performed. Results: One hundred and seventy (73.91%) out of the 230 urinary isolates were sensitive to fosfomycin in our study with equivalent efficacy among outdoor and indoor patients. Among the Gram-positive isolates, 34 (60.71%) out of 56 isolates were sensitive to fosfomycin. Among the Gram-negative isolates, 136 (78.16%) out of 174 were sensitive to fosfomycin which was higher than other commonly used drugs for UTI. ESBL production did not affect the overall susceptibility to the drug. Conclusion: The convenience of a single-dose regimen, broad range of activity proven in vitro and in vivo, and minimal propensity for promoting resistant pathogens make fosfomycin an attractive regimen for the treatment of complicated and uncomplicated community- and hospital-acquired UTIs. This study also reveals an alarming finding of high level of resistance among Klebsiella spp., which could well turn out to be a limiting factor in the clinical usefulness of this drug, which warrants further clinical studies regarding the drug in India.