From the Guidelines
The recommended treatment for uncomplicated urinary tract infections (UTIs) is a short course of antibiotics, with fosfomycin (Monurol) 3 grams as a single dose being a suitable option, as stated in the 2021 guidelines from the American College of Physicians 1.
Key Considerations
- Fosfomycin has minimal resistance and a low propensity for collateral damage, making it an appropriate choice for therapy where it is available 1.
- Other first-line therapy options include nitrofurantoin (Macrobid) 100 mg twice daily for 5 days and trimethoprim-sulfamethoxazole (Bactrim) 160/800 mg twice daily for 3 days 1.
- Fluoroquinolones like ciprofloxacin 250 mg twice daily for 3 days may be used as second-line options in patients with allergies or in areas with high resistance rates, but they have a high propensity for adverse effects and should be reserved for patients with a history of resistant organisms 1.
Treatment Approach
- Patients should complete the full course of antibiotics even if symptoms improve quickly.
- If symptoms worsen or don't improve within 48-72 hours, patients should seek further medical evaluation as this may indicate antibiotic resistance or a complicated infection requiring different treatment.
- While taking antibiotics, patients should drink plenty of water to help flush the bacteria from the urinary system.
- Phenazopyridine (Pyridium) 100-200 mg three times daily for 2 days can be used for symptom relief of pain and burning, though it will turn urine orange.
Rationale
- The 2021 guidelines from the American College of Physicians recommend short-course antibiotics with either nitrofurantoin for 5 days, trimethoprim–sulfamethoxazole (TMP–SMZ) for 3 days, or fosfomycin as a single dose for women with uncomplicated bacterial cystitis 1.
- The guidelines also recommend short-course therapy with fluoroquinolones (5 to 7 days) or TMP–SMZ (14 days) for men and women with uncomplicated pyelonephritis, based on antibiotic susceptibility 1.
From the FDA Drug Label
Fosfomycin tromethamine granules for oral solution is indicated only for the treatment of uncomplicated urinary tract infections (acute cystitis) in women due to susceptible strains of Escherichia coli and Enterococcus faecalis. The evidence supports the use of fosfomycin for the treatment of uncomplicated urinary tract infections (UTIs), specifically acute cystitis in women, due to susceptible strains of Escherichia coli and Enterococcus faecalis 2.
- The recommended treatment is fosfomycin tromethamine granules for oral solution.
- It is not indicated for the treatment of pyelonephritis or perinephric abscess.
From the Research
Fosfomycin Use in UTI
- Fosfomycin is a potential treatment option for uncomplicated urinary tract infections (UTIs) in women, with a single dose of 300mg being effective 3.
- The efficacy and safety of fosfomycin have been compared to nitrofurantoin in the treatment of uncomplicated UTIs, with no significant differences in clinical and microbiological cure rates found 3.
- Fosfomycin has also been used in the treatment of complicated UTIs, including those caused by extended-spectrum β-lactamase-producing Escherichia coli (ESBLEC) 4, 5.
- The use of fosfomycin in the treatment of community-acquired lower UTIs caused by ESBLEC has been evaluated, with clinical success documented in >78% of patients 5.
Treatment Recommendations
- Fosfomycin is recommended as a first-line treatment option for uncomplicated UTIs, particularly in areas with high resistance rates to other antibiotics 6, 7.
- The choice of antibiotic should be based on factors such as pharmacokinetics, spectrum of activity, resistance prevalence, and potential for adverse effects 6.
- Fosfomycin has been shown to have a favorable adverse event profile and is a cost-effective option for the treatment of UTIs 5, 7.