Fosfomycin - Revision history

Aidan at 17:45, 19 September 2024

2024-09-19T17:45:11Z

← Older revision		Revision as of 17:45, 19 September 2024
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	*Intravenous: fosfomycin disodium 8 g IV q12h		*Intravenous: fosfomycin disodium 8 g IV q12h
	*CNS or other severe infection: fosfomycin disodium 8 to 12 g IV q12h		*CNS or other severe infection: fosfomycin disodium 8 to 12 g IV q12h
			*Continuous infusion may result in better PK/PD: 8 g IV load followed by 16-24 g continuous infusion over 24 hours[[CiteRef::antonello2021fo]]
	*Continuous infusion may result in better PK/PD: 8 g IV load followed by 16-24 g continuous infusion over 24 hours<ref>Antonello RM, Di Bella S, Maraolo AE, Luzzati R. Fosfomycin in continuous or prolonged infusion for systemic bacterial infections: a systematic review of its dosing regimen proposal from in vitro, in vivo and clinical studies. Eur J Clin Microbiol Infect Dis. 2021 Jun;40(6):1117-1126. doi: [https://doi.org/10.1007/s10096-021-04181-x 10.1007/s10096-021-04181-x]. Epub 2021 Feb 18. PMID: 33604721; PMCID: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8139892/ PMC8139892].</ref>

	=== Renal Dosing ===		=== Renal Dosing ===

Aidan at 17:41, 21 July 2023

2023-07-21T17:41:41Z

← Older revision		Revision as of 17:41, 21 July 2023
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	*Safe in pregnancy		*Safe in pregnancy

			== Further Reading ==

			* Fosfomycin. ''Clin Microbiol Rev''. 2016 Apr;29(2):321-47. doi: [https://doi.org/10.1128/CMR.00068-15 10.1128/CMR.00068-15]. PMID: [https://pubmed.ncbi.nlm.nih.gov/26960938/ 26960938]; PMCID: [http://www.ncbi.nlm.nih.gov/pmc/articles/pmc4786888/ PMC4786888].

	[[Category:Antibiotics]]		[[Category:Antibiotics]]

Aidan at 17:40, 21 July 2023

2023-07-21T17:40:30Z

← Older revision		Revision as of 17:40, 21 July 2023
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	*Active against many Gram-positive bacteria, including MSSA, MRSA, [[Staphylococcus epidermidis]], [[Streptococcus pneumoniae]], [[Enterococcus faecalis]], [[Enterococcus faecium]], and [[VRE]]		*Active against many Gram-positive bacteria, including MSSA, MRSA, [[Staphylococcus epidermidis]], [[Streptococcus pneumoniae]], [[Enterococcus faecalis]], [[Enterococcus faecium]], and [[VRE]]
	*Active against many Gram-negative bacteria, including regular [[Enterobacterales]], CRE, and ESBL		*Active against many Gram-negative bacteria, including regular [[Enterobacterales]], CRE, and ESBL
			**Includes [[Salmonella]], [[Shigella]], [[E. coli]], [[Klebsiella]], [[Enterobacter]], [[Serratia]], [[Citrobacter]], and [[Proteus mirabilis]]
	**Unclear if effective against [[Pseudomonas]]		**Unclear if effective against [[Pseudomonas]]
	*Limited activity against gut anaerobes, but does cover [[Peptostreptococcus]]		*Limited activity against gut anaerobes, but does cover [[Peptostreptococcus]]
	*Intrinsic resistance in [[Acinetobacter]], [[Stenotrophomonas maltophilia]], [[Burkholderia cepacia]], some [[coagulase-negative staphylococci]] ([[Staphylococcus capitis]] and [[Staphylococcus saprophyticus]]), [[Morganella morganii]], and [[Mycobacterium tuberculosis]]		*Intrinsic resistance in [[Pseudomonas]] (probably), [[Acinetobacter]], [[Stenotrophomonas maltophilia]], [[Burkholderia cepacia]], some [[coagulase-negative staphylococci]] ([[Staphylococcus capitis]] and [[Staphylococcus saprophyticus]]), [[Morganella morganii]], and [[Mycobacterium tuberculosis]]

	===PK/PD===		===PK/PD===

Aidan: /* Dosing */

2022-11-17T16:40:09Z

Dosing

← Older revision		Revision as of 16:40, 17 November 2022
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	*Intravenous: fosfomycin disodium 8 g IV q12h		*Intravenous: fosfomycin disodium 8 g IV q12h
	*CNS or other severe infection: fosfomycin disodium 8 to 12 g IV q12h		*CNS or other severe infection: fosfomycin disodium 8 to 12 g IV q12h
			*Continuous infusion may result in better PK/PD: 8 g IV load followed by 16-24 g continuous infusion over 24 hours<ref>Antonello RM, Di Bella S, Maraolo AE, Luzzati R. Fosfomycin in continuous or prolonged infusion for systemic bacterial infections: a systematic review of its dosing regimen proposal from in vitro, in vivo and clinical studies. Eur J Clin Microbiol Infect Dis. 2021 Jun;40(6):1117-1126. doi: [https://doi.org/10.1007/s10096-021-04181-x 10.1007/s10096-021-04181-x]. Epub 2021 Feb 18. PMID: 33604721; PMCID: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8139892/ PMC8139892].</ref>

	=== Renal Dosing ===		=== Renal Dosing ===

Aidan: /* Dosing */ renal dosing

2022-10-15T14:40:41Z

Dosing: renal dosing

← Older revision		Revision as of 14:40, 15 October 2022
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	=== Renal Dosing ===		=== Renal Dosing ===

	* No dosage adjustment necessary for oral, though elimination may be prolonged		* Oral: no dosage adjustment necessary for oral, though elimination may be prolonged
			* Intravenous
	* CrCl 40 to 80 mL/min: normal dose
			** CrCl >=130 mL/min: maximum indicated dose for indication (up to 24 g/day in 3 to 4 divided doses)
⚫	* CrCl ~~31-40~~: 70% of normal daily dose
	* CrCl 21-30: ~~60%~~ of ~~normal~~ ~~daily~~ ~~dose~~		** CrCl 40-129 mL/min: normal dose, in 2 to 4 divided doses
	* CrCl 11-20: 40% of normal daily dose		** CrCl 30-39: 70-80% of normal daily dose, in 2 to 3 divided doses
	* CrCl ~~≤10~~: 20% of normal daily dose		** CrCl 20-29: 50-70% of normal daily dose, in 2 to 3 divided doses
			** CrCl 10-19: 30-50% of normal daily dose, in 2 to 3 divided doses
⚫	* Intermittent hemodialysis: 2 g after each session
		⚫	** CrCl <10: 20% of normal daily dose, in 1 to 2 divided doses
		⚫	** Intermittent hemodialysis: 2 g after each session (up to 4 g for severe or less susceptible infections)

	==Safety==		==Safety==

Aidan at 14:36, 15 October 2022

2022-10-15T14:36:29Z

← Older revision		Revision as of 14:36, 15 October 2022
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	=== Renal Dosing ===		=== Renal Dosing ===

			* No dosage adjustment necessary for oral, though elimination may be prolonged
	* CrCl 40 to 80 mL/min: normal dose		* CrCl 40 to 80 mL/min: normal dose
	* CrCl 31-40: 70% of normal daily dose		* CrCl 31-40: 70% of normal daily dose

Aidan: Text replacement - " species]]" to "]]"

2022-02-20T06:38:27Z

Text replacement - " species]]" to "]]"

← Older revision		Revision as of 06:38, 20 February 2022
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	**Unclear if effective against [[Pseudomonas]]		**Unclear if effective against [[Pseudomonas]]
	*Limited activity against gut anaerobes, but does cover [[Peptostreptococcus]]		*Limited activity against gut anaerobes, but does cover [[Peptostreptococcus]]
	*Intrinsic resistance in [[Acinetobacter ~~species~~]], [[Stenotrophomonas maltophilia]], [[Burkholderia cepacia]], some [[coagulase-negative staphylococci]] ([[Staphylococcus capitis]] and [[Staphylococcus saprophyticus]]), [[Morganella morganii]], and [[Mycobacterium tuberculosis]]		*Intrinsic resistance in [[Acinetobacter]], [[Stenotrophomonas maltophilia]], [[Burkholderia cepacia]], some [[coagulase-negative staphylococci]] ([[Staphylococcus capitis]] and [[Staphylococcus saprophyticus]]), [[Morganella morganii]], and [[Mycobacterium tuberculosis]]

	===PK/PD===		===PK/PD===

Aidan: /* Spectrum of Activity */

2020-08-29T20:00:45Z

Spectrum of Activity

← Older revision		Revision as of 20:00, 29 August 2020
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	**Unclear if effective against [[Pseudomonas]]		**Unclear if effective against [[Pseudomonas]]
	*Limited activity against gut anaerobes, but does cover [[Peptostreptococcus]]		*Limited activity against gut anaerobes, but does cover [[Peptostreptococcus]]
			*Intrinsic resistance in [[Acinetobacter species]], [[Stenotrophomonas maltophilia]], [[Burkholderia cepacia]], some [[coagulase-negative staphylococci]] ([[Staphylococcus capitis]] and [[Staphylococcus saprophyticus]]), [[Morganella morganii]], and [[Mycobacterium tuberculosis]]

	===PK/PD===		===PK/PD===

	*Efficacy predicted by time-above-MIC		*Efficacy predicted by time above MIC
			*Oral bioavailability 34 to 58%; higher if taken on an empty stomach
			*Elimination half-life of 5.7 hours, 93 to 99% excreted unchanged in the urine

	=== Breakpoints ===		===Breakpoints===

	* Determined by agar (not broth) dilution		*Determined by agar (not broth) dilution
	* [[Enterobacterales]]: susceptible if MIC ≤32, resistance if MIC >32		*[[Enterobacterales]]: susceptible if MIC ≤32, resistance if MIC >32
	* [[Pseudomonas aeruginosa]]: no MIC breakpoints; ECV is 128 mg/L		*[[Pseudomonas aeruginosa]]: no MIC breakpoints; ECV is 128 mg/L
	* [[Acinetobacter]]: no MIC breakpoints or ECV		*[[Acinetobacter]]: no MIC breakpoints or ECV

	==Dosing==		==Dosing==
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	*Uncomplicated UTI: fosfomycin 3 g PO once		*Uncomplicated UTI: fosfomycin 3 g PO once
	*Complicated UTI: fosfomycin 3 g PO q72h for 2 to 3 doses		*Complicated UTI: fosfomycin 3 g PO q72h for 2 to 3 doses
			*Intravenous: fosfomycin disodium 8 g IV q12h
			*CNS or other severe infection: fosfomycin disodium 8 to 12 g IV q12h

			=== Renal Dosing ===

			* CrCl 40 to 80 mL/min: normal dose
			* CrCl 31-40: 70% of normal daily dose
			* CrCl 21-30: 60% of normal daily dose
			* CrCl 11-20: 40% of normal daily dose
			* CrCl ≤10: 20% of normal daily dose
			* Intermittent hemodialysis: 2 g after each session

	==Safety==		==Safety==

Aidan at 15:08, 26 August 2020

2020-08-26T15:08:02Z

← Older revision		Revision as of 15:08, 26 August 2020
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	*Safe in pregnancy		*Safe in pregnancy

			[[Category:Antibiotics]]

Aidan: /* Background */

2020-08-26T15:04:22Z

Background

← Older revision		Revision as of 15:04, 26 August 2020
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	== Background ==		==Background==

	=== Mechanism of Action ===		===Mechanism of Action===

	* Inhibits an enzyme-catalyzed reaction in cell wall synthesis		*Inhibits an enzyme-catalyzed reaction in cell wall synthesis
	* Bacteridical		*Bacteridical

	=== Spectrum of Activity ===		===Spectrum of Activity===

	* Active against many Gram-positive bacteria, including MSSA, MRSA, [[Staphylococcus epidermidis]], [[Streptococcus pneumoniae]], [[Enterococcus faecalis]], [[Enterococcus faecium]], and [[VRE]]		*Active against many Gram-positive bacteria, including MSSA, MRSA, [[Staphylococcus epidermidis]], [[Streptococcus pneumoniae]], [[Enterococcus faecalis]], [[Enterococcus faecium]], and [[VRE]]
	* Active against many Gram-negative bacteria, including regular [[Enterobacterales]], CRE, and ESBL		*Active against many Gram-negative bacteria, including regular [[Enterobacterales]], CRE, and ESBL
	** Unclear if effective against [[Pseudomonas]]		**Unclear if effective against [[Pseudomonas]]
	* Limited activity against gut anaerobes, but does cover [[Peptostreptococcus]]		*Limited activity against gut anaerobes, but does cover [[Peptostreptococcus]]

	=== PK/PD ===		===PK/PD===

	* Efficacy predicted by time-above-MIC		*Efficacy predicted by time-above-MIC

	== ~~Dosing~~ ==		=== Breakpoints ===

			* Determined by agar (not broth) dilution
⚫	* Uncomplicated UTI: fosfomycin 3 g PO once
			* [[Enterobacterales]]: susceptible if MIC ≤32, resistance if MIC >32
⚫	* Complicated UTI: fosfomycin 3 g PO q72h for 2 to 3 doses
			* [[Pseudomonas aeruginosa]]: no MIC breakpoints; ECV is 128 mg/L
			* [[Acinetobacter]]: no MIC breakpoints or ECV

	== ~~Safety~~ ==		==Dosing==

		⚫	*Uncomplicated UTI: fosfomycin 3 g PO once
	=== Monitoring ===
		⚫	*Complicated UTI: fosfomycin 3 g PO q72h for 2 to 3 doses

			==Safety==
⚫	* Hypokalemia, high sodium content, dose-limiting nausea, vomiting, and diarrhea

	=== ~~Pregnancy~~ ===		===Monitoring===

		⚫	*Hypokalemia, high sodium content, dose-limiting nausea, vomiting, and diarrhea
⚫	* Safe in pregnancy

			===Pregnancy===

		⚫	*Safe in pregnancy