Fosfomycin in a single dose versus a 7-day course of amoxicillin–clavulanate for the treatment of asymptomatic bacteriuria during pregnancy

Abstract

The purpose of this paper was to compare the efficacy of a single dose of 3 g of fosfomycin to that of a 7-day regimen of amoxicillin-clavulanate in the treatment of asymptomatic bacteriuria during pregnancy. A randomised, prospective, interventional, analytical, longitudinal study was undertaken, in which the efficacy of two antibiotic regimens (one short and the other long) in the treatment of pregnant women with asymptomatic bacteriuria is compared. One hundred and nine patients were randomly assigned to two groups: 56 were treated with amoxicillin-clavulanate and 53 with fosfomycin. The two groups were similar in terms of co-morbidity, treatments received during pregnancy, obstetric, gynaecological and surgical history and laboratory data. The efficacy of the two regimens was similar and the eradication rate was over 80% in both groups (P = 0.720) (relative risk [RR] 1.195, 95% confidence interval [CI]: 0.451-3.165). The number of reinfections was greater in the amoxicillin-clavulanate group (P = 0.045). The secondary effects were lower in the fosfomycin group (P = 0.008). There were no significant differences in the number of persistences (P = 0.39), development of symptomatic urinary infections (P = 0.319) or recurrences (P = 0.96). Treatment with a single dose of fosfomycin is as effective as the standard course of treatment with amoxicillin-clavulanate and may be preferable due to its simpler administration and the smaller number of reinfections.

Urinary Tract Infection and Bacteriuria in Pregnancy

“…63 Although there are no adequate studies specifically examining teratogenic risk, several trials have examined the use of single-dose fosfomycin for treatment of ASB and lower UTIs in pregnancy with no reported adverse outcomes. 34,62,[65][66][67][68] Overall, fosfomycin has a broad spectrum of activity against many MDR organisms, and it may have an increasing role in the antimicrobial armamentarium for treatment of lower UTIs.…”

Clinical Management of an Increasing Threat: Outpatient Urinary Tract Infections Due to Multidrug-Resistant Uropathogens: Table 1.

“…Single-dose fosfomycin is well studied in community-acquired UTIs and continues to produce acceptable cure rates against nonresistant uropathogens [22]. Clinical cure rates in recent studies ranged from 87% to 93% [23,24], and microbiological cure rates ranged from 80% to 83% [25,26]. A retrospective study of 41 hospitalized patients with UTIs caused by MDR uropathogens and treated with fosfomycin demonstrated an overall microbiological cure rate of 59% [27].…”

“…Patients with microbiological failure had significantly more solid organ transplants and ureteral stents, suggesting more complicated UTIs. In general, fosfomycin is well tolerated, causing fewer adverse events than other agents in multiple studies [23,25].…”

Oral Treatment Options for Ambulatory Patients with Urinary Tract Infections Caused by Extended-Spectrum-β-Lactamase-Producing Escherichia coli

“…Stabilized with tromethamine, it can be orally administered as a single dose of 3 g for the treatment of UTIs (17). It is well tolerated, with negligible side effects, such as diarrhea and headache, and is applicable during pregnancy (6,7).…”