From the Guidelines
Fosfomycin is effective against Streptococcus species causing urinary tract infections, as evidenced by its inclusion as a recommended treatment option for uncomplicated cystitis in women by the American College of Physicians 1. The American College of Physicians recommends fosfomycin as a single dose for the treatment of uncomplicated bacterial cystitis in women, which includes infections caused by Streptococcus species. Fosfomycin tromethamine (Monurol) is typically administered as a single 3-gram oral sachet dissolved in water for uncomplicated UTIs caused by susceptible strains of Streptococcus. This one-time dosing regimen offers excellent patient compliance compared to multi-day antibiotic courses. Some key points to consider when prescribing fosfomycin for UTIs include:
- Fosfomycin works by inhibiting bacterial cell wall synthesis through a unique mechanism different from other antibiotics, specifically by inhibiting the enzyme phosphoenolpyruvate transferase 1.
- The drug achieves high urinary concentrations that persist for 24-48 hours after a single dose, making it particularly effective for urinary tract infections.
- However, for complicated UTIs, pyelonephritis, or systemic infections, alternative antibiotics might be preferred.
- Patients should be advised that fosfomycin may cause mild gastrointestinal side effects such as diarrhea, nausea, or headache in some cases. It's also worth noting that fosfomycin has been shown to be active against multidrug-resistant pathogens, including vancomycin-resistant enterococci (VRE), methicillin-resistant S. aureus (MRSA), and extended-spectrum β-lactamase (ESBL)–producing gram-negative rods 1. Overall, fosfomycin is a useful option for the treatment of uncomplicated UTIs caused by Streptococcus species, offering a convenient single-dose regimen and a unique mechanism of action that helps to minimize the development of resistance.
From the Research
Fosfomycin Coverage for Strep UTIs
- Fosfomycin is a broad-spectrum antibiotic that has been shown to be effective against a wide range of bacteria, including Gram-negative and some Gram-positive bacteria 2.
- However, the provided studies do not specifically address the effectiveness of fosfomycin against Streptococcal UTIs.
- The studies primarily focus on the treatment of UTIs caused by Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis 3, 4, 5, 6.
- One study mentions that fosfomycin demonstrated high activity against other Enterobacterales and gram-positive organisms, including Staphylococcus aureus, but does not provide information on Streptococcal species 4.
- Another study found that fosfomycin was effective against Enterococcal UTIs, including vancomycin-resistant Enterococcus (VRE) 6, but this is not directly relevant to Streptococcal UTIs.
Limitations of Current Evidence
- There are no research papers provided that specifically address the effectiveness of fosfomycin against Streptococcal UTIs.
- The available evidence primarily focuses on the treatment of UTIs caused by other bacterial species.
- Further studies are needed to determine the effectiveness of fosfomycin against Streptococcal UTIs.