Oral and Intravenous Fosfomycin for the Treatment of Complicated Urinary Tract Infections

Table 1

Oral fosfomycin for the treatment of patients with complicated lower urinary tract infection (cLUTI).

Study	Number of patients	Mean age (years)	Gender (male/female)	Complicating factors/comorbidities	Pathogens	Dosing regimen	Microbiologic cure (%)	Clinical cure (%)	Relapse rate (%)	Reinfection (%)
Moroni et al. [4]	49	—	20/29	—	—	21 patients—3 grams single dose; 28 patients—3 grams once daily for 2-3 days or once daily for 11 days (few cases) multi-dose	—	Single dose, 57.1%; Multidose, 82.1%	—	—
Pullukcu et al. [5]	52	55	25/27	∼1.7	All ESBL-producing E. coli	3 grams every other day for 3 doses	78.5%	94.3%	0%	10.7%
Senol et al. [6]	27	58	13/14	∼1.7	All ESBL-producing E. coli	3 grams every other day for 3 doses	59.3%	77.8%	6.3%	6.3%
Neuner et al. [7]	41	62	19/22	∼4.4	All MDR urinary pathogens	3 grams for 2.9 ± 1.8 doses	58.5%	—	24.4%	17.1%
Qiao et al. [8]	146	50	—	—	—	3 grams every other day for 3 doses	74.6%	70.5%	14.6% relapse or reinfection
Matthews et al. [9]	75	73	18/57	∼1.2	52/75 E. coli; 31/52 ESBL-producing; E. coli	53 patients, 3 gram single dose; 8 patients, 3 grams for two doses; 14 patients, 3 grams for ≥3 doses	52.5%	68.9%; “functional cure”	—	10.7%
Veve et al. [10]	89	69	23/66	∼3.7	All ESBL-producing E. coli	12 patients, 3 grams single dose; 20 patients, 3 grams every 48 hours for ∼3 doses; 55 patients, 3 grams every 72 hours for ∼3 doses; 2 patients, 3 grams daily for ∼4.5 doses	—	85.4%	—	—
Jacobson et al. [11]	71	75	21/50	—	40/71 E. coli; 8/40 ESBL-producing; E. coli	35 patients, 3 grams single dose; 10 patients, 3 grams every 48 hours for 3 doses; 26 patients, 3 grams every 72 hours for 3 doses	—	83.0%	3.0%	—
Giancola et al. [12]	57	79	19/38	∼2.2	36/57 MDR pathogens	26 patients, 3 grams single dose; 20 patients, 3 grams every 48–72 hours for 3 doses; 11 patients, varying regimens	75.0%	96.4%	10%	15%
Cai et al. [13]	35	66	28/6	>1	23/35 E. coli; 17/35 ESBL-producing	3 grams once daily for 2 days followed by 3 grams every 48 hours for 2 weeks	—	85.7%	2.9% relapse or reinfection

Table created from data in references [4–13]. Complicating factors/comorbidities, average number of complicating factors/comorbidities per patient (see definition of complicated UTI). ESBL: extended-spectrum β-lactamase; MDR: multidrug-resistant (resistant to at least one agent in ≥3 antimicrobial classes). Microbiological cure defined as eradication of urinary pathogen as documented by urine culture at completion of therapy (exception: references [7, 12] define microbiological cure, as a negative urine culture after completion of therapy and/or absence of relapse or reinfection). Clinical cure defined as resolution of UTI symptoms including dysuria, urgency, and frequency. “Functional cure” was defined by Matthews et al. as (i) evidence of microbiological cure and/or (ii) no follow-up sample available presumably due to clinical cure. Relapse defined as reappearance of same causative pathogen in urine culture at follow-up. Reinfection defined as presence of a different urinary pathogen in urine culture than at initial presentation at the time of follow up.