Fosfomycin: Difference between revisions
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==Background== |
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===Mechanism of Action=== |
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*Inhibits an enzyme-catalyzed reaction in cell wall synthesis |
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*Bacteridical |
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===Spectrum of Activity=== |
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*Active against many Gram-positive bacteria, including MSSA, MRSA, [[Staphylococcus epidermidis]], [[Streptococcus pneumoniae]], [[Enterococcus faecalis]], [[Enterococcus faecium]], and [[VRE]] |
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*Active against many Gram-negative bacteria, including regular [[Enterobacterales]], CRE, and ESBL |
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**Unclear if effective against [[Pseudomonas]] |
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*Limited activity against gut anaerobes, but does cover [[Peptostreptococcus]] |
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===PK/PD=== |
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*Efficacy predicted by time-above-MIC |
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=== Breakpoints === |
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* Determined by agar (not broth) dilution |
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* [[Enterobacterales]]: susceptible if MIC ≤32, resistance if MIC >32 |
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* [[Pseudomonas aeruginosa]]: no MIC breakpoints; ECV is 128 mg/L |
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* [[Acinetobacter]]: no MIC breakpoints or ECV |
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==Dosing== |
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=== Monitoring === |
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==Safety== |
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===Monitoring=== |
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===Pregnancy=== |
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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
References
- ^ Roberta Maria Antonello, Stefano Di Bella, Alberto Enrico Maraolo, Roberto Luzzati. 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. European Journal of Clinical Microbiology & Infectious Diseases. 2021;40(6):1117-1126. doi:10.1007/s10096-021-04181-x.
