The Potential Role of Fosfomycin in Neonatal Sepsis Caused by Multidrug-Resistant Bacteria

• Published in: Drugs (New York, N.Y.) Vol. 77; no. 9; pp. 941 - 950
• Main Authors: Li, Grace, Standing, Joseph F., Bielicki, Julia, Hope, William, van den Anker, John, Heath, Paul T., Sharland, Mike
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.06.2017; Springer Nature B.V
• Subjects: Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - pharmacokinetics; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobial agents; Bacteria; Bacteria - drug effects; Clinical outcomes; Clinical trials; Drug resistance; Drug Resistance, Multiple, Bacterial; E coli; Enterobacteriaceae; Escherichia coli; Fosfomycin; Fosfomycin - administration & dosage; Fosfomycin - adverse effects; Fosfomycin - pharmacokinetics; Fosfomycin - therapeutic use; Humans; Infant, Newborn; Internal Medicine; Klebsiella pneumoniae; Leading Article; Medical research; Medicine; Medicine & Public Health; Morbidity; Mortality; Multidrug resistance; Multidrug resistant organisms; Neonatal Sepsis - drug therapy; Neonatal Sepsis - microbiology; Neonates; Newborn babies; Pharmacokinetics; Pharmacology; Pharmacology/Toxicology; Pharmacotherapy; Pseudomonas aeruginosa; Sepsis; Staphylococcus; Staphylococcus infections; Urinary tract diseases; Urinary tract infections; Urogenital system; Klebsiella Species; Neonatal Sepsis; Late Preterm Infant; Preterm Infant; Fosfomycin
• ISSN: 0012-6667; 1179-1950; 1179-1950
• DOI: 10.1007/s40265-017-0745-x

The broad-spectrum activity of fosfomycin, including against multidrug-resistant (MDR) strains, has led to renewed interest in its use in recent years. Neonatal sepsis remains a substantial cause of morbidity and mortality at a global level, with evidence that MDR bacteria play an increasing role. The evidence for use of fosfomycin in neonatal subjects is limited. We summarise current knowledge of the pharmacokinetics and clinical outcomes for the use of fosfomycin in neonatal sepsis and issues specific to neonatal physiology. While fosfomycin has a broad range of coverage, we evaluate the extent to which it may be effective against MDR bacteria in a neonatal setting, in light of recent evidence suggesting it to be most effective when administered in combination with other antibiotics. Given the urgency of clinical demand for treatment of MDR bacterial sepsis, we outline directions for further work, including the need for future clinical trials in this at-risk population.