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PubMed1999

In-vitro activity of fosfomycin against vancomycin-resistant enterococci.

The effect of fosfomycin against 69 vancomycin-resistant isolates of Enterococcus faecium (VanA), five of E. faecium (VanB), 11 of Enterococcus faecalis (VanA), three of E. faecalis (VanB), 10 of Enterococcus gallinarum (VanC1) and two of Enterococcus casseliflavus (VanC2) and glycopeptide-sensitive E. faecium (n = 8) and E. faecalis (n = 10) was tested in vitro. Fosfomycin inhibited 97%, 94% and 96% of the vancomycin-resistant strains, according to results of agar dilution, broth microdilution, and a disc diffusion method (DIN 58940). The disc diffusion test by the NCCLS method does not include fosfomycin; using breakpoints suggested by Andrews et al. (< or = 11 mm, resistant; > or = 18 mm, susceptible), 5% of the vancomycin-resistant strains tested would have been considered fosfomycin resistant. Minimal inhibitory concentrations of most vancomycin-resistant isolates were in the intermediate sensitivity range, yielding an MIC50 of 32 mg/L and an MIC90 of 64 mg/L. Moreover the majority of inhibitory zone sizes by the disc diffusion method (DIN 58940) corresponded to intermediate susceptibility. These results suggest that fosfomycin at a high dosage and possibly used in combination with other drugs could be a potentially useful drug for the treatment of infections caused by vancomycin-resistant enterococci.

Anti-Bacterial Agents↗
PubMed2006

Single-dose pharmacokinetics of fosfomycin during continuous venovenous haemofiltration.

OBJECTIVES: Dosage recommendations for fosfomycin are available for haemodialysed patients but there are no data for patients undergoing continuous renal replacement therapy. Therefore, the present study was designed to determine the concentration-versus-time profile of fosfomycin in continuous venovenous haemofiltration (CVVH). PATIENTS AND METHODS: A total of 12 anuric intensive care patients (10 males and 2 females) with suspected or proven infection requiring parenteral antibiotic therapy were included in the study. All patients underwent CVVH. Blood samples were drawn from the arterial (input) and venous (output) line of the extracorporeal circuit after application of a single dose of 8 g of fosfomycin. Ultrafiltration samples were collected from the outlet of the ultrafiltrate compartment of the haemofilter. Fosfomycin in the samples was quantified by gas chromatography. RESULTS: The peak serum concentration was 442.7+/-124 mg/L at the arterial port. The trough serum level was 103.1+/-36.6 mg/L at the arterial port after 720 min. The mean value of the area under the concentration-versus-time curve from 0 to 12 h (AUC0-12) was 2159.4+/-609.8 mg.h/L. Mean total removal of the drug was 76.7+/-6.2%. The mean calculated clearance was 1.1+/-0.2 L/h for CLHF. Mean CLtot was 6.4+/-7.7 L/h. CONCLUSIONS: A regimen of 8.0 g of fosfomycin every 12 h, which is usually used in patients with intact renal function, should be an appropriate antimicrobial treatment for patients undergoing CVVH.

Aged↗
PubMed1987

Effect of antibiotics on immediate hypersensitivity reactions in vitro: suppression of IgE-mediated histamine release from peripheral blood basophils by fosfomycin.

The effect of antibiotics on allergic reactions was studied in vitro using the release of histamine from human peripheral blood leukocytes (basophils) after incubation with anti-IgE. For the several antibiotics we tested, including beta-lactams and aminoglycosides, none had the capacity to enhance antigen-induced histamine release, but some of them (minocycline, polymyxin B, and fosfomycin) suppressed the release of histamine in a dose-dependent manner. Since fosfomycin has proved to be capable of suppressing IgE-mediated histamine release non-cytotoxically, the effect of fosfomycin on histamine release induced by other secretagogues was further studied. The suppression of histamine release was also demonstrated when the leukocytes, preincubated with fosfomycin, were challenged with either Ca ionophore A 23187 or a synthetic peptide, formyl-methionyl-leucyl-phenylalanine (FMLP). We concluded that some antibiotics, particularly fosfomycin, have the capacity to suppress histamine release mediated by various secretagogues, suggesting they may possess an anti-allergic property as well as a bactericidal activity.

Anti-Bacterial Agents↗
PubMed2007

Intravenous and intramuscular pharmacokinetics of a single-daily dose of disodium-fosfomycin in cattle, administered for 3 days.

Pharmacokinetic parameters of fosfomycin in cattle were determined after administration of buffered disodium fosfomycin either intravenously (i.v.) or intramuscularly (i.m.) at a dose of 20 mg/kg/day for 3 days. Calculated concentrations at time zero and maximum serum concentrations were 34.42 and 10.18 mug/mL, respectively. The variables determined, the elimination half-life of the drug remained unchanged during the 3 days ( = 1.33 +/- 0.3 h for the i.v. route and = 2.17 +/- 0.4 h for the i.m. route). Apparent volumes of distribution suggest moderated distribution out of the central compartment (V(darea) = 673 mL +/- 27 mL/kg and V(dss) = 483 +/- 11 mL/kg). Bioavailability after i.m. administration was 74.52%. Considering fosfomycin as a time-dependent antibacterial drug, plasma concentration vs. time profiles obtained in this study, suggest that clinically effective plasma concentrations of fosfomycin could be obtained for up to 8 h following i.v. administration and approximately 10 h after i.m. injection of 20 mg/kg, for susceptible bacteria. In addition to residue studies in milk and edible tissues, a series of clinical assessments, using fosfomycin at 20 mg/kg b.i.d. or t.i.d. are warranted before this antibacterial drug should be considered for use in cattle.

Animals↗
PubMed1987

Enhancement of jejunal and colonic absorption of fosfomycin by promoters in the rat.

A means of enhancing absorption of the antibiotic, fosfomycin, has been investigated using promoters in rat jejunum and colon. Polyoxyethylene lauryl ether (BL-9EX), saponin, the sodium salts of fatty acids and mixed micelles were effective at 1% in increasing fosfomycin absorption. Of the sodium salts of saturated medium-chain fatty acids examined, the strength of this effect was in the order caprate greater than laurate greater than caprylate. Mixed micelles, consisting of fusogenic lipids and sodium taurocholate, enhanced fosfomycin absorption independently of the degree of unsaturation of the lipids; their effectiveness far exceeded that of sodium taurocholate alone. The action of these promoters was more evident in the colon than in the jejunum, except for the sodium salts of bile acids and disodium ethylenediaminetetraacetate (EDTA-2Na). The effects of glycocholate and taurocholate were essentially the same at both absorption sites, but that of EDTA-2Na was much greater in the jejunum than the colon. Improved fosfomycin absorption was observed at more than 0.5% sodium caprate concentrations in both the jejunum and colon. BL-9EX was effective at 0.1% in the jejunum or at 0.05% in the colon. The effectiveness at these low concentrations demonstrates the practicality of promoters for improving fosfomycin absorption with only minor membrane damage, especially in the colon.

Animals↗
PubMed1985

In vitro activity of fosfomycin, alone and in combination, against methicillin-resistant Staphylococcus aureus.

We tested 148 strains of clinical isolates of methicillin-resistant Staphylococcus aureus against fosfomycin alone and in combination with methicillin, cefamandole, gentamicin, trimethoprim, and vancomycin. Fosfomycin inhibited 90% of the 148 methicillin-resistant S. aureus strains at a concentration of 4 micrograms/ml. Synergism was observed in 97 strains (66%) with fosfomycin-cefamandole and in 69 strains (46%) with fosfomycin-methicillin. The combinations of fosfomycin with vancomycin, gentamicin, and trimethoprim were indifferent in most strains.

Cross Infection↗
PubMed1988

Formation of an adduct between fosfomycin and glutathione: a new mechanism of antibiotic resistance in bacteria.

Plasmid-borne resistance to fosfomycin in bacteria is due to modification of the antibiotic molecule by a glutathione S-transferase that catalyzes the formation of a covalent bond between the sulfhydryl residue of the cysteine in glutathione and the C-1 of fosfomycin. This reaction results in opening of the epoxide ring of the antibiotic to form an inactive adduct, the structure of which was confirmed by nuclear magnetic resonance. Dialyzed extracts prepared from resistant Escherichia coli strains were unable to modify fosfomycin unless exogenous glutathione was added to the reaction mixtures. Similarly, mutants defective in glutathione biosynthesis were susceptible to fosfomycin, despite harboring a resistance plasmid. Extracts of resistant but not susceptible strains could join glutathione to 1-chloro-2,4-dinitrobenzene, confirming the nature of the enzymatic activity. Adduct formation appeared to be specific for glutathione: none of the other thiols tested (cysteine, N-acetylcysteine, and dithiothreitol) could modify fosfomycin.

Drug Resistance, Microbial↗
PubMed1999

Emergence of fosfomycin-resistant isolates of Shiga-like toxin-producing Escherichia coli O26.

We evaluated the susceptibilities of 129 Shiga-like toxin-producing Escherichia coli (STEC) isolates to various antibiotics. The numbers of isolates for which MICs were high (> or = 128 micrograms/ml) were as follows: 5 for fosfomycin, 14 for ampicillin, 1 for cefaclor, 6 for kanamycin, 22 for tetracycline, and 2 for doxycycline. For two isolates of STEC O26 MICs of fosfomycin were high (1,024 and 512 micrograms/ml, respectively). Conjugation experiments and glutathione S-transferase assays suggested that the fosfomycin resistance in these isolates was determined not by a plasmid but chromosomally. The amount of active intracellular fosfomycin in these STEC isolates was 100- to 200-fold less than that in E. coli C600 harboring pREFTT47B408 in the presence of either L-alpha-glycerophosphate or glucose-6-phosphate. Cloning, sequencing, and Northern blot analysis demonstrated that the transcriptional level of the murA gene encoding UDP-N-acetylglucosamine enolpyruvoyl transferase in these isolates was greater than that in E. coli C600. Our results suggest that the fosfomycin resistance in these STEC isolates is due to concurrent effects of alteration of the glpT and/or uhp transport systems and of the enhanced transcription of the murA gene.

Alkyl and Aryl Transferases↗
PubMed1975

Enteropathogenic Esch. coli gastroenteritis in premature infants and children treated with fosfomycin.

Forty-two infants, some premature, with enteropathogenic Esch. coli (EPEC) gastroenteritis were treated with an oral suspension of fosfomycin in a dose of 100 and 200 mg/kg per day. After the treatment there were 11 secondary clinical infections (6 reinfections and 5 relapses) which received a second treatment with fosfomycin. In total, 53 treatments were made with fosfomycin and in 92% of the cases there was both clinical and bacteriological cure. 93% of the EPEC strains were sensitive to fosfomycin in vitro, their minimum inhibitory concentrations being less than 64 mug/ml. The concentration of fosfomycin in blood and faeces was assayed by a diffusion plate microbiological method in a group of these children, showing that this antibiotic is partly absorbed and the rest eliminated in the faeces, where its concentration was found to be very high. Tolerance of the product was good, and there were neither toxic nor side effects.

Anti-Bacterial Agents↗
PubMed2003

Fosfomycin for the initial treatment of acute haematogenous osteomyelitis.

BACKGROUND AND AIMS: At our institution there has been a dichotomous antimicrobial treatment behaviour for acute haematogenous osteomyelitis (AHOM) since 1984. The surgical department favoured fosfomycin as initial choice and the medical department beta lactams. We aimed to compare the performance of both strategies. METHODS: Data from patients discharged with the diagnosis of AHOM between January 1984 and January 1998 were gathered from the charts by means of a questionnaire. Patients receiving fosfomycin treatment (FT) were compared with those receiving fosfomycin plus other antimicrobials (FT+) and those receiving no fosfomycin treatment (NFT). RESULTS: A total of 103 patients aged 0.1-15.5 years (mean 6.5, median 6.9) with AHOM received no surgical treatment initially. In 23 (22.3%) FT was instilled initially, in 47 (45.6%) FT+, and in 33 (32.0%) NFT. The pathogen was established in 30%, 36%, and 42% of FT, FT+, and NFT patients, respectively, Staphylococcus aureus being the predominant isolate. Mean C reactive protein levels and erythrocyte sedimentation rates normalised in all treatment groups after two and four weeks, respectively. The mean duration of intravenous antimicrobial treatment in FT patients was 2.5 weeks, in FT+ patients 3.1 weeks, and in NFT patients 3.8 weeks (p < 0.05), whereas the mean duration of intravenous plus oral treatment was comparable (7.1 v 6.8 v 6.5 weeks). CONCLUSIONS: The leucocyte penetrating fosfomycin performed similarly to extracellular beta lactams in the treatment of AHOM. Intravenous treatment for longer than 2.5 weeks offered no advantage.

Acute Disease↗
PubMed2006

[Fosfomycin trometamol: multiple-dose regimen for the treatment of lower urinary tract infections].

INTRODUCTION: A short antibiotic regimen is recommended for the treatment of uncomplicated lower urinary tract infection. Nevertheless, the treatment to follow in other situations is not so clearly defined. When the person affected by lower urinary tract infection is not a young woman, it is recommended to treat at least 7 days, and quinolones or cotrimoxazole are the antibiotics most often used. However, because of the frequency of drug resistance in this type if infection, it is advisable to apply antibiotics with lower rates of resistance, such as fosfomycin trometamol, for longer treatment periods than the often-used single dose. METHODS: Using the data on urinary elimination of fosfomycin after a single dose obtained in a prior study in healthy volunteers, we simulated the urinary concentrations of this antibiotic following administration of two doses. In addition, we calculated the interval of administration required to achieve urinary concentrations greater than 16 mg/L, the critical concentration of sensitivity for Escherichia coli, one of the most commonly implicated microorganisms in these infections. RESULTS: Fosfomycin concentrations in urine persisted above the defined cut-off for 161 hours after administration of two 3-g doses of fosfomycin trometamol, 72 hours apart. This implied an efficacy time of 66% in a period of 7 days. CONCLUSION: From the pharmacokinetic viewpoint, the optimum dosage of fosfomycin trometamol to achieve appropriate urinary concentrations along 7 days is administration of two 3-g doses, 72 hours apart.

Adult↗
PubMed1977

The passage of fosfomycin into the cerebrospinal fluid in children's meningitis.

This report deals with the results of a study that was made on the passage of fosfomycin into the CSF in 22 children with meningitis (11 parotideal meningitis and 11 meningococcal meningitis). The plasma and liquor levels of fosfomycin were determined in the acute phase of the illness and after the normalization of the CSF, with the object of studying the passage of the antibiotic through the blood-brain barrier in the presence and absence of meningeal inflammation. A greater permeability of the meninges was found to exist when they were in an inflammatory state and there seems to be a certain accumulative effect in the CSF when the fosfomycin is administered by intravenous perfusion. The concentrations that were obtained in the CSF were not high enough to justify the exclusive use of fosfomycin in the treatment of meningitis. Nevertheless, considering its wide antibacterial spectrum, its MIC against different microbial species and its lack of toxicity, we believe that fosfomycin can be of use when associated with other antibiotics in the treatment of meningitis caused by S. aureus, D. pneumoniae, H. influenzae, E. coli, P. mirabilis and S. marcescens.

Acute Disease↗
PubMed1977

Fosfomycin in infantile acute gastroenteritis.

A clinical test was carried out on 83 children suffering from infectious diarrhoeal processes who were treated with fosfomycin with the oral and paranteral route. Coproculture was carried out in all the children before the beginning of treatment and in 51 of them it was repeated at the end of treatment. Antibiograms were made on the isolated germs and their MIC to fosfomycin studied. Tolerance and secondary effects of the medicament were also studied. The study was considered insufficient in 13 patients so that the evaluation was based on 70, making 4 failures and 60 clinical cures. Administration of fosfomycin causes the eradication of serotypeable E. coli and is followed by an increase in the number of Proteus sp. and Klebsiella/Enterobacter. The sensitivity of the faecal flora to fosfomycin has been very high, except for the strains of Proteus sp. and Klebsiella/Enterobacter. The accumulative percentage of the MIC to fosfomycin of all the strains isolated shows that more than 75% of them are inhibited at concentrations under 32 mug/ml. Tolerance was good and no secondary effects were observed except for the sporadic rise in the SGPT of the children.

Acute Disease↗
PubMed1990

Fosfomycin trometamol versus amoxycillin--single-dose multicenter study of urinary tract infections.

A randomized trial comparing single-dose therapy with fosfomycin trometamol 3 g versus amoxycillin 3 g was carried out in four centers. There were 158 female patients between 18 and 65 years. The major infecting organism in both groups was Escherichia coli (80%). The overall evaluation showed that fosfomycin trometamol eradicated 81.2% of bacteria and amoxycillin 71.8%. In women younger than 45 years, the cure rate was 88.8% for fosfomycin trometamol and 72.9% for amoxycillin. There was more persistence in the amoxycillin group, but equal recurrence and reinfection for both agents. The most common failure was with E. coli for both agents. Side effects were minimal with 8.7% for fosfomycin trometamol and 11.5% for amoxycillin. Fosfomycin trometamol is effective therapy of acute urinary tract infections in adult females and in selected situations was superior to amoxycillin.

Adolescent↗
PubMed1990

Fosfomycin trometamol versus norfloxacin in the treatment of uncomplicated lower urinary tract infections of the elderly.

Ten years of controlled clinical trials supported single-dose therapy efficacy and safety in uncomplicated lower urinary tract infections (UTI). Both local and systematic factors contribute to the high UTI prevalence seen in elderly people. A controlled open randomized study was undertaken to evaluate the clinical efficacy and safety of a new fosfomycin derivative (fosfomycin trometamol) given in a single dose in the treatment of uncomplicated lower UTIs in 60 elderly subjects (mean age 68.4 years). A single 3-gram fosfomycin trometamol dose was compared to a 7-day treatment with norfloxacin 400 mg b.i.d. Midstream urocultures and susceptibility tests were performed to diagnose a UTI and at 3-5 and 25-35 days after discontinuation of therapies. Our results, showing comparable clinical and bacteriological resolution rates in both groups (76.6 and 73.3% in the fosfomycin-trometamol- and norfloxacin-treated subjects, respectively), support the single-dose fosfomycin trometamol efficacy in uncomplicated lower UTIs in an elderly population, suggesting it as a convincing alternative to longer therapeutic regimens.

Aged↗
PubMed1985

Protective effect of fosfomycin against aminoglycoside ototoxicity.

The protective effect of fosfomycin against aminoglycoside (dibekacin)-induced ototoxicity was studied in rats. Rats were injected with 100 or 50 mg/kg of dibekacin with or without 500 mg/kg of fosfomycin for 60 or 120 consecutive days. Inner ear damage appeared to be more reduced histopathologically in animals given both dibekacin and fosfomycin than in animals given dibekacin alone. Similarly, renal damage appeared to be reduced histopathologically and functionally by the combined administration of dibekacin and fosfomycin. The mechanism of reduced ototoxicity may be as follows: fosfomycin inhibits the accumulation of dibekacin in the kidney, and reduces its concentration in the kidney and serum. Consequently, the amounts of dibekacin reaching the inner ear are decreased, and ototoxicity is reduced.

Acetylglucosaminidase↗
PubMed1987

Pharmacokinetic profile of fosfomycin trometamol (Monuril).

The kinetics of fosfomycin in serum and in urine was studied in 5 healthy volunteers after intravenous administration of disodium fosfomycin and after oral administration of trometamol fosfomycin at 50 mg/kg. The presence of secondary peaks in serum kinetics, more evident after oral administration, requires the use of a compartmental model with enterohepatic recirculation to which all the data of each subject were simultaneously fitted. The following values of the various pharmacokinetic parameters were calculated: central volume 10.6 +/- 0.92 liters; bioavailability 0.58 +/- 0.04; delay time in the recirculation 2.00 +/- 0.92 h; half-life 2.43 +/- 0.31 h; total clearance 8.3 +/- 1.6 l/h; urinary clearance 7.0 +/- 0.9 l/h; peak level 32.1 +/- 3.0 micrograms/ml; time of the peak 2.2 +/- 0.44 h. The fosfomycin concentration in urine remains above 1,000 micrograms/ml for 12 h and above 100 micrograms/ml for 48 h. The oral kinetics of fosfomycin is dose-dependent, as shown by serum and urine kinetics in other 4 volunteers after oral administration of 2, 3, 4 and 5 g; the fraction of the dose excreted by urine goes from 50% for 2 g to 22% for 5 g.

Administration, Oral↗
PubMed1987

Trometamol-fosfomycin (Monuril) bioavailability and food-drug interaction.

A new water-soluble monobasic salt of fosfomycin with trometamol has recently been developed for oral administration. The objective of this study was to evaluate the pharmacokinetics of trometamol-fosfomycin (Monuril) in serum and in urine in 10 healthy volunteers after oral administration of one single dose (50 mg/kg). In the same volunteers the concentrations of fosfomycin were measured before and after food absorption, in serum and urine samples taken at t = 0, 2, 4, 6, 8 and 24 h after the dose (plus 0.5 and 1 h for serum samples). The measurement of fosfomycin levels was carried out by means of a microbiological procedure using Proteus mirabilis ATCC 21100 as test organism. The results indicated at 2 or 4 h serum peak levels ranging from 9 to 28 micrograms/ml, with mean values of about 17-21 micrograms/ml. The urine concentrations reached 2,000-2,500 micrograms/ml at 2 h, with high levels maintained till the 8th hour (1,200-2,750 micrograms/ml) and persistence of noticeable concentrations at 24 h (100-700 micrograms/ml). The influence of food absorption, even variable, decreased significantly the rate of absorption, with lower serum and urine levels, as measured in the same volunteers. Taking into account this factor influencing the bioavailability and the distribution of the drug, the results of the study confirm that a high proportion of the oral dose of trometamine salt of fosfomycin is absorbed; the extremely high urinary recovery of the drug even after food administration could certainly allow short-course therapy or even single-dose therapy in the treatment of uncomplicated urinary tract infection.

Administration, Oral↗