Clinical Value Of Intravenous Fosfomycin Combinations

• Published in: İzmir Tıp Fakültesi Dergisi Vol. 2; no. 3; pp. 146 - 153
• Main Authors: SARI, Tugba, KÖSE, Şükran, TURGUT, Hüseyin, ÖZGÜLER, Müge, AKKAYA IŞIK, Sinem, ÖZKAN ACAR, Ayşe
• Format: Journal Article
• Language: English
• Published: 25.09.2023
• ISSN: 2822-4833; 2822-4833
• DOI: 10.57221/izmirtip.1126596

Aims:Due to the increasing number of Multi-Drug Resistance (MDR) and Extensively Drug Resistant (XDR) pathogens and the difficulties in developing new antibiotics, some combinations are being tried. Fosfomycin is a phosphonic acid derivative UDP-N-acetyl glucosamine (MurA) inhibitor. Fosfomycin inhibits bacteria cell wall synthesis in its first step. It acts against both gram-positive and gram-negative Multi-Drug Resistance (MDR) and Extensive Drug-Resistant (XDR) bacteria. It prevents bacterial invasion into the urinary system and respiratory tract epithelİum. It was aimed to evaluate the clinical and microbiological response rates of intravenous fosfomycin treatment in gram-negative MDR and XDR bacterial infections in this study. Methods: Total 77 patients from four different centers where used intravenous fosfomycin treatment were involved to the study. It was evaluated clinical and microbiological response in 72 hours after the beginning of treatment and at the end of treatment. Clinical and microbiological response have been evaluated in the study population. Results: While 41 of the patients were female (53.2%), 36 were male (46.8%), it is found that their mean age was 60.5. Clinical response rates 72 hours after the initiation of treatment and at the end of treatment were 46 (59.7%) and 45 (58.4%), respectively. Microbiological eradication rate was achieved in 40 (51.9%) patients in the first 72 hours and in 39 (50.6%) patients at the end of the treatment. Clinical response and microbiological eradication rates after seventy two hours and at the end of treatment were found to be similar with together. Conclusions: As a result, fosfomycin may be an alternative in combination therapy due to its low side effect profile and lack of drug interaction in the treatment of MDR and XDR pathogens. ÖZET Amaç Multi-Drug Resistance (MDR) ve Extensively Drug Resistant (XDR) patojenlerin artması ve yeni antibiyotiklerin geliştirilmesindeki zorluklar nedeniyle, bazı kombinasyonlar denenmektedir. Fosfomisin, fosfonik asit derive UDP-N-asetil glukozamin (MurA) inhibitörüdür. Fosfomisin bakteriyel hücre duvarı sentezini ilk aşamada inhibe eder. Gram negatif ve gram pozitif MDR ve XDR bakterilere etkilidir. Üriner sistem ve respiratuar sistem epiteline invazyonu engeller. Gereç ve yöntemler: Dört farklı merkezden intravenöz fosfomisin kullanılan toplam 77 hasta çalışmaya alındı. Bulgular: Hastaların 41’i (%53.2) kadın, 36’sı (%46.8) erkekti. Yaş ortalamaları 60.5 idi. Hastaların 46’sında (%59.7) tedaviden 72 saat sonra klinik yanıt alınmışken, tedavi sonunda 45 (%58.4) bulundu. Mikrobiyal eradikasyon oranı ilk 72 saatte 40 (%51.9) hastada ulaşılmışken, 39 (%50.6) hastada tedavi sonunda ulaşılmıştır. Tedaviden yetmiş iki saat sonraki ve tedavi sonu klinik yanıt oranları birbirleri ile benzer bulunmuştur. Sonuç: Sonuç olarak, MDR ve XDR patojenlerin tedavisinde düşük yan etki profili ve ilaç etkileşimi olmaması nedeniyle, kombinasyon tedavisinde bir alternatif olabilir.