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Urinary Tract Infections, Genital Ulcers and Syphilis
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
In pregnancy, treat empirically if no cultures are available. Co-amoxiclav, cephalexin and fosfomycin may be used in pregnancy. Nitrofurantoin can be used in the second and third trimester. Avoid trimethoprim, as it crosses the placenta and may affect folate metabolism.
Antimicrobials in Pregnant Women
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Nitrofurantoin, fosfomycin and systemic metronidazole are safe to use. However, nitrofurantoin is contraindicated within 30 days of delivery as it may cause neonatal haemolysis. Although fosfomycin is safe to use during the second and third trimesters, there is insufficient data regarding the use of fosfomycin in the first trimester.
Enterococcus: An Important Opportunistic Pathogen—Basic and Clinical Aspects
Published in Dongyou Liu, Handbook of Foodborne Diseases, 2018
Karen Flores-Moreno, Claudia Mayoral-Teran, Yolanda Lopez-Vidal
After confirming the species causing the infection and verifying the infection is monomicrobial, a susceptibility test must be performed to administer the most effective antibiotic to eliminate the infection. In the case of susceptible species, the treatment can start with the use of β-lactam antibiotics, while nitrofurantoin is recommended to treat uncomplicated urinary tract infections.61 Some studies have obtained good results using fosfomycin to treat urinary tract infections caused by Enterococcus.62
Emerging issues on Staphylococcus aureus endocarditis and the role in therapy of daptomycin plus fosfomycin
Published in Expert Review of Anti-infective Therapy, 2023
Cristina García de la Mària, Maria-Alexandra Cañas, Mariana Fernández-Pittol, Anders Dahl, Javier García-González, Marta Hernández-Meneses, Guillermo Cuervo, Asunción Moreno, Jose M. Miró, Francesc Marco
Fosfomycin is unique among bactericidal antibiotics given its peculiar mechanism of action. It acts as an analog of phosphoenolpyruvate, i.e. by inhibiting the initial step in peptidoglycan biosynthesis by irreversibly binding to the essential enzyme MurA. It also has the ability to produce a synergistic effect against staphylococci in combination with a wide variety of other antibiotics. In particular, the synergistic and bactericidal combination of fosfomycin with daptomycin has been shown to be extraordinarily active against endocarditis-producing isolates of MSSA and MRSA in both in vitro studies and in vivo models of experimental endocarditis. The combination has also been shown to prevent the development of intrinsic resistance to daptomycin during treatment, a feared and well-described complication in high-inocula infections, as epitomized by endocarditis.
Intravenous fosfomycin for the treatment of patients with bone and joint infections: a review
Published in Expert Review of Anti-infective Therapy, 2022
Katerina G. Tsegka, Georgios L. Voulgaris, Margarita Kyriakidou, Anastasios Kapaskelis, Matthew E. Falagas
Experimental studies showed that fosfomycin has high activity against staphylococcal, enterococcal and ESBL-producing E. coli biofilms, particularly in combination with other antibacterials [10–12]. In addition, fosfomycin exerts bactericidal activity against intracellular persisting bacteria, e.g. Staphylococcus aureus [13]. Another useful effect is its broad synergistic effect with other antibiotics, including beta-lactams, given its unique mode of action [14]. As severe bone infections are often complicated by factors such as abscess formation and tissue hypoxia which render bacteria more tolerant to most antibiotics, fosfomycin´s higher antimicrobial activity under low oxygen conditions and low pH and sufficient penetration into abscess fluid may be beneficial for treatment of these difficult-to treat-infections [15–18].
Intravenous fosfomycin for the treatment of multidrug-resistant pathogens: what is the evidence on dosing regimens?
Published in Expert Review of Anti-infective Therapy, 2019
George Dimopoulos, Despoina Koulenti, Suzanne L. Parker, Jason A. Roberts, Kostoula Arvaniti, Garyphalia Poulakou
A French prospective cohort study evaluated the efficacy of IV fosfomycin at a dose of 4 g every 8 h in adults and children, for the treatment of 116 infections, caused mostly by MDR and XDR pathogens [64]. Fosfomycin was administered mainly as part of a combination regimen, with main indications bacteremia, osteomyelitis, lung infection, and UTI. The proportion of critical illness was notable, with 44% of the patients being hospitalized in the ICU and 22.4% presenting with septic shock. P. aeruginosa and MRSA represented the most frequently bacteria involved. Infection by MDR organisms was demonstrated in 71.5% of cases, involving 28 P. aeruginosa strains, among which 24 were XDR. A favorable outcome was reported in 76.8% of cases. Based on a preliminary retrospective study of eight patients with 75% favorable clinical and microbiological outcome when treated with fosfomycin plus high dose-extended infusion of doripenem, a subsequent retrospective study evaluated fosfomycin combined to doripenem or colistin. Fosfomycin was given IV as 2 g every 8 h in combination with either high dose-4 h infusion of doripenem or colistin (2.5 mg/kg every 12 h) [65,66]. Forty-nine patients with VAP or HAP caused by P. aeruginosa were evaluated. Meropenem and imipenem median MICs were >32 μg/ml and doripenem MIC was 4 μg/ml, respectively [65]. No difference in clinical cure (60 vs. 58%) or bacterial eradication (72 vs. 75%) and all-cause mortality (40 vs 42%) were observed.