Potential Role of Fosfomycin in the Treatment of Community-Acquired Lower Urinary Tract Infections Caused by Extended-Spectrum β-Lactamase-Producing Escherichia coli

Extended-spectrum -lactamase-producing Escherichia coli (ESBLEC) are emerging pathogens causing urinary tract infections (UTIs) in community patients worldwide. Treatment for community-acquired ESBLEC UTIs, especially in the outpatient setting, may be problematic because many of the strains are resistant to the traditional oral therapies. Fosfomycin is an oral agent that is approved for the treatment of uncomplicated UTIs caused by Enterococcus faecalis and E. coli. Data evaluating the clinical efficacy of fosfomycin for the treatment of community-acquired ESBLEC lower UTIs are limited. Three studies evaluating fosfomycin in the treatment of ESBLEC lower UTIs have been conducted. Clinical success was documented in >78% of patients. From the available data, it seems that fosfomycin may be an effective and reasonable treatment option for outpatient management of community-acquired ESBLEC UTIs, excluding pyelonephritis. Fosfomycin is a very attractive agent because it is available orally, has limited drug interactions, has a favorable adverse event profile, and would be very cost effective considering the potential complications of inadequate treatment and the high cost associated with parenteral therapies. Limitations to the clinical use of fosfomycin may include optimal dose and duration not being established, fosfomycin not often being included on culture and sensitivity reports and emerging resistance.