From the Guidelines
The recommended treatment for uncomplicated urinary tract infections (UTIs) is a short course of antibiotics, with fosfomycin (Monurol) as a single 3-gram dose being a suitable option, as stated in the most recent guideline from 2021 1.
Key Considerations
- The choice of antibiotic should be based on the patient's medical history, allergy status, and local resistance patterns.
- First-line therapy typically includes nitrofurantoin (Macrobid) 100 mg twice daily for 5 days, trimethoprim-sulfamethoxazole (Bactrim) 160/800 mg twice daily for 3 days, or fosfomycin (Monurol) as a single 3-gram dose, as recommended by the American College of Physicians in 2021 1.
- Fluoroquinolones like ciprofloxacin 250 mg twice daily for 3 days may be used as second-line options for patients allergic to first-line medications or in areas with high resistance rates, but they are generally reserved due to side effect concerns.
Treatment Rationale
- These treatments are effective because they target the bacterial infection (most commonly E. coli) that causes inflammation of the urinary tract lining, while supporting the body's natural elimination of bacteria through increased fluid intake.
- Symptoms typically improve within 1-2 days of starting treatment, but the full course of antibiotics should always be completed to prevent recurrence and antibiotic resistance.
- Pain relievers like phenazopyridine (Pyridium) 200 mg three times daily can help manage painful urination while waiting for antibiotics to take effect.
Additional Guidance
- The Infectious Diseases Society of America (IDSA) and the European Society for Microbiology and Infectious Diseases (ESCMID) also recommend fosfomycin as a suitable option for uncomplicated UTIs, as stated in their 2010 update 1.
- However, the most recent guideline from 2021 1 takes precedence, and its recommendations should be followed in clinical practice.
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 recommended treatment for uncomplicated urinary tract infections (UTIs) is fosfomycin for women with infections due to susceptible strains of Escherichia coli and Enterococcus faecalis 2.
- Key points:
- Fosfomycin is indicated for uncomplicated UTIs in women.
- The drug is effective against Escherichia coli and Enterococcus faecalis.
From the Research
Treatment Options for Uncomplicated Urinary Tract Infections (UTIs)
- The recommended first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females includes a 5-day course of nitrofurantoin, a 3-g single dose of fosfomycin tromethamine, or a 5-day course of pivmecillinam 3.
- Fosfomycin tromethamine is an oral antimicrobial indicated for the treatment of uncomplicated lower UTIs, active against common uropathogens, including organisms resistant to other antibiotics 4.
- A single dose of fosfomycin tromethamine is well absorbed and produces therapeutic concentrations in the urine for 2-4 days, with clinical trials suggesting it is as effective as 7- to 10-day treatment regimens of standard agents 4.
Efficacy and Safety of Fosfomycin
- Clinical studies have shown that a single-dose administration regimen of fosfomycin tromethamine achieves high clinical recovery (88.9%) and bacteriological (94.9%) eradication rates, with gastrointestinal side effects found in only 4.3% of patients 5.
- Fosfomycin trometamol has good in vitro activity against common uropathogens, including Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, and Staphylococcus saprophyticus, with susceptibility remaining relatively stable over time 6.
- A systematic review and meta-analysis found no significant differences in clinical and microbiological cure rates between fosfomycin and nitrofurantoin, with the incidence of adverse events slightly higher in the fosfomycin group 7.
Comparison with Other Treatments
- Fosfomycin trometamol has similar clinical and/or bacteriological efficacy to 3- to 7-day regimens of ciprofloxacin, norfloxacin, cotrimoxazole, or nitrofurantoin in women with uncomplicated lower UTIs 6.
- Single-dose fosfomycin trometamol also has similar bacteriological efficacy to a 5-day course of cefuroxime axetil or a 7-day course of amoxicillin/clavulanic acid in pregnant women with asymptomatic bacteriuria 6.