Is fosfomycin the new ciprofloxacin?  Recently I have seen an increased number of prescriptions for fosfomycin in some of the long term care facilities. Fosfomycin is an antibiotic commonly indicated for urinary tract infection. The Infectious disease Society of America (IDSA) has recommended it as first line option for the treatment of urinary tract infection, along with trimethoprim-sulfamethoxazole and nitrofurantoin. This is in context to the increasing resistance of E Coli to fluroquinolones and as well as other antibiotics such as Amoxicillin-Clavulate in United States. We do have a different resistance pattern in Canada.

Fosfomycin has other attractive features too – it is given as a single dose treatment, safe in pregnancy, have few drug interactions and it is also rare to develop antibiotic resistance.  Its mechanism of action is also significantly different from other antibiotics, rendering the chance of cross resistance low and infrequent.

But does that mean we should start prescribing it as a first line option for urinary tract infection?

Here are some basic facts on Fosfomcyin:

  • Name: Fosfomcyin (Munurol)
  • Indication: It is indicated for uncomplicated urinary tract infections (acute cystitis) in women due to susceptible strains of Escherichia Coli and Enterococcus faecalis.
  • Dose: Single dose of 3 g in 3 to 4 oz (90 to 120 mL) of water. No dosage adjustment is required for geriatrics,  renal impairment or  hepatic impairment.
  • Coverage: It is currently listed as a general benefit by Ontario Drug Benefits Program.

I can certainly see fosfomycin having its advantages over other antibiotics. However, currently it is the only oral antibiotic that is sensitive to ESBL-producing Escherichia Coli. As such, I like to reserve the use of fosfomycin in this type of infections, especially in patients when intravenous therapy is not an option. I think over prescribing fosfomycin as a first line agent may have adverse outcomes down the road.

What do you think? Do you like to prescribe or recommend fosfomyin in your practice for uncomplicated urinary tract infections? I like to hear your view on its place of therapy for urinary tract infections.