Fosfomycin: Difference between revisions

Revision as of 15:04, 26 August 2020

Background

Mechanism of Action

Inhibits an enzyme-catalyzed reaction in cell wall synthesis
Bacteridical

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-negative bacteria, including regular Enterobacterales, CRE, and ESBL
- Unclear if effective against Pseudomonas
Limited activity against gut anaerobes, but does cover Peptostreptococcus

PK/PD

Efficacy predicted by time-above-MIC

Breakpoints

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

Dosing

Uncomplicated UTI: fosfomycin 3 g PO once
Complicated UTI: fosfomycin 3 g PO q72h for 2 to 3 doses

Safety

Monitoring

Hypokalemia, high sodium content, dose-limiting nausea, vomiting, and diarrhea

Pregnancy

Safe in pregnancy

@@ Line 1: / Line 1: @@
-== 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