In patients hospitalized with uncomplicated urinary tract infections, even if the infection is caused by resistant strains of microorganisms, the use of phosphomycin inside is effective.

According to a retrospective study, the results of which were presented to the 16th International Congress on Infectious Diseases, the recovery rate with phosphomycin was 83%. At the same time, even in patients for whom clinical recovery was not achieved, the frequency of treatment failure was only around 3%.

Researchers from the Regional Medical Center (Orlando, Florida, United States) recently limited the use of fluoroquinolones in hospitals, then the use of meropenem was limited. Fosfomycin is well studied and successfully used in outpatients, especially in patients with uncomplicated cystitis. At the same time, it cannot be said that the use of fosfomycin has been well studied in hospitalized patients.

A retrospective study analyzed data from 71 patients hospitalized with urinary tract infections (UTIs) from November 2012 to November 2013. About 60% of patients were diagnosed with community acquired UTIs requiring hospitalization in a hospital. At the same time, approximately 38% of all urinary tract infections were nosocomial. The average age of the patients was 75 years, 39% of people suffered from diabetes mellitus, renal failure was detected in 21% and urological interventions were performed in 38% of the patients.

About a quarter of all patients received systemic antibiotics in the previous 2 weeks before prescribing fosfomycin, and just over half of patients received other antibiotics with fosfomycin simultaneously for the treatment of infections from another location (not from the urinary tract).

Of all the pathogens isolated from UTI, 40 strains are Gram-negative bacilli, of which 9 strains produced extended spectrum beta-lactamases (BLRS) and 9 were found to be Pseudomonas aeruginosa. In some patients, several microorganisms were isolated simultaneously. According to microbiological research, 3 strains were moderately resistant and 3 were resistant to fosfomycin.

It should be noted that almost half of the patients received a clinical response to a single dose (3 g) of phosphomycin. A small proportion of patients required the administration of 3 doses of fosfomycin with an interval of 72 hours and an even smaller number of patients prescribed fosfomycin every 48 hours at a dose of 3 g (3 doses in total).

With the resolution of all the symptoms of the disease (fever, leukocytosis, painful frequent urination) and the absence of need for reprocessing when the same microorganism was isolated within 30 days, the situation was considered to be a cure. clinical. However, there have been cases that do not fall under the definition of "clinical recovery", but that does not necessarily mean treatment failure. Thus, out of 12 patients who have not obtained clinical recovery, only 2 can be considered as an ineffective treatment. Proteus mirabilis and Klebsiella pneumoniae have been isolated from these patients.

In 4 patients, strains resistant to fosfomycin in vitro were isolated, and the treatment was modified before evaluating the efficacy.

Treatment was also changed in one patient after nephrostomy with infection caused by P. aeruginosa and in 2 patients who needed treatment for competitive infection from a different location.

Three other patients were prescribed treatment for urinary tract infections within 30 days, however, other microorganisms were isolated during the bacteriological examination.

Fosfomycin has been shown to be very effective in the treatment of urinary tract infections caused by a variety of microorganisms. So, with UTI caused by P. aeruginosa, the efficacy of fosfomycin was 78%.

In the cohort of patients with an infection caused by BLRS-producing microorganisms, (n = 8), 100% efficacy of phosphomycin was observed, and in the cohort of patients with a urinary tract infection caused by of enterococci, the efficacy was 86%.

The treatment was very well tolerated and a small number of patients had adverse events.

Since the drug has virtually no systemic effect, phosphomycin is unlikely to damage normal intestinal microflora and promote the growth of Clostridium difficile, i.e. the risk of developing antibiotic-associated diarrhea is minimal.

In the study cohort, only 7% of patients developed C. difficile, but all patients received other broad-spectrum antibiotics.

The only problem, according to the researchers, is the cost of fosfomycin, which in the United States is around $ 50 per dose.