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VOLUME 25 , ISSUE 9 ( September, 2021 ) > List of Articles

BRIEF RESEARCH COMMUNICATION

A Real-world Study on Prescription Pattern of Fosfomycin in Critical Care Patients

Abhijit M Deshmukh, Saiprasad Patil, Sagar Bhagat, Hanmant Barkate

Keywords : Critically ill adults, Fosfomycin, Retrospective study

Citation Information : Deshmukh AM, Patil S, Bhagat S, Barkate H. A Real-world Study on Prescription Pattern of Fosfomycin in Critical Care Patients. Indian J Crit Care Med 2021; 25 (9):1055-1058.

DOI: 10.5005/jp-journals-10071-23958

License: CC BY-NC 4.0

Published Online: 08-09-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Background: This study presents a real-world scenario for prescription pattern, efficacy, and safety data on the current clinical use of intravenous fosfomycin in critically ill patients in Indian settings. Patients and methods: This was a retrospective cohort study conducted for a period of 10 months among critically ill patients admitted to hospital's critical care unit. The primary objective of the study was to analyze the prescription pattern of intravenous fosfomycin, and the secondary objective was to evaluate the safety profile and patient outcomes. Results: A total of 309 patients were enrolled, and they were diagnosed with bacteremia (45.3%), pneumonia (15.85%), septic shock (14.24%), and urinary tract infections (UTI) (13.91%). The average dose of fosfomycin given was 11.7 ± 4.06 gm/day. The average duration of the therapy was 4.85 ± 3.59 days with a median duration of 4 days. Fosfomycin was given at 8 hourly dosing frequency to maximum (45.6%) cases. Hypokalemia was the most observed adverse event. The overall survival was seen in 55% of patients. Conclusion: Our data suggest that UTI, infection caused by Escherichia coli, and a daily dose of >12 g were associated with better clinical outcomes. The overall survival of critically ill patients receiving fosfomycin was 55%.


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  1. Falagas ME, Kastoris AC, Kapaskelis AM, Karageorgopoulos DE. Fosfomycin for the treatment of multidrug-resistant, including extended-spectrum β-lactamase producing, Enterobacteriaceae infections: a systematic review. Lancet Infect Dis 2010;10(1):43–50. DOI: 10.1016/S1473-3099(09)70325-1.
  2. Silver LL. Fosfomycin: mechanism and resistance. Cold Spring Harb Perspect Med 2017;7(2):a025262. DOI: 10.1101/cshperspect.a025262. PMID: 28062557; PMCID: PMC5287057.
  3. Saiprasad P, Krishnaprasad K. Exploring the hidden potential of fosfomycin for the fight against severe gram-negative infections. Indian J Med Microbiol 2016;34(4):416–420. DOI: 10.4103/0255-0857.195379.
  4. Docobo-Pérez F, Drusano GL, Johnson A, Goodwin J, Whalley S, Ramos-Martín V, et al. Pharmacodynamics of fosfomycin: insights into clinical use for antimicrobial resistance. Antimicrob Agents Chemother 2015;59(9):5602–5610. DOI: 10.1128/AAC.00752-15. Available from: https://aac.asm.org/content/59/9/5602.
  5. Falagas ME, Vouloumanou EK, Samonis G, Vardakasa KZ. Fosfomycin. Clin Microbiol Rev 2016;29(2):321–347. DOI: 10.1128/CMR.00068-15.
  6. Drobnic L, Quiles M, Rodríguez A. A study of the levels of fosfomycin in the cerebrospinal fluid in adult meningitis. Chemotherapy 1977;23(1):180–188. DOI: 10.1159/000222045. Available from: https://www.karger.com/Article/FullText/222045.
  7. Bandeira M, Carvalho PA, Duarte A, Jordao L. Exploring dangerous connections between Klebsiella pneumoniae biofilms and healthcare-associated infections. Pathogens 2014;3(3): 720–731. DOI: 10.3390/pathogens3030720.
  8. Schintler MV, Traunmuller F, Metzler J, Kreuzwirt G, Spendel S, Mauric O, et al. High fosfomycin concentrations in bone and peripheral soft tissue in diabetic patients presenting with bacterial foot infection. J Antimicrob Chemother 2009;64(3):574–578. DOI: 10.1093/jac/dkp230. Available from: https://academic.oup.com/jac/article-lookup/doi/10.1093/jac/dkp230.
  9. Rosso-Fernandez C, Sojo-Dorado J, Barriga A, Lavin-Alconero L, Palacios Z, Lopez-Hernandez I, et al. Fosfomycin versus meropenem in bacteraemic urinary tract infections caused by extended-spectrum -lactamase-producing Escherichia coli (FOREST): study protocol for an investigator-driven randomised controlled trial. BMJ Open 2015;5(3):e007363–e007363. DOI: 10.1136/bmjopen-2014-007363.
  10. Maraki S, Samonis G, Rafailidis PI, Vouloumanou EK, Mavromanolakis E, Falagas ME. Susceptibility of urinary tract bacteria to fosfomycin. Antimicrob Agents Chemother 2009;53(10):4508–4510. DOI: 10.1128/AAC.00721-09.
  11. Hashemian SM, Farhadi Z, Farhadi T. Fosfomycin: the characteristics, activity, and use in critical care. Ther Clin Risk Manag 2019;15:525–530. DOI: 10.2147/TCRM.S199119. Available from: https://www.dovepress.com/fosfomycin-the-characteristics-activity-and-use-in-critical-care-peer-reviewed-article-TCRM.
  12. Zhanel GG, Walkty AJ, Karlowsky JA. Fosfomycin: a first-line oral therapy for acute uncomplicated cystitis. Can J Infect Dis Med Microbiol 2016;2016:1–10. DOI: 10.1155/2016/2082693. Available from: http://www.hindawi.com/journals/cjidmm/2016/2082693/.
  13. Karageorgopoulos DE, Wang R, Yu XH, Falagas ME. Fosfomycin: evaluation of the published evidence on the emergence of antimicrobial resistance in gram-negative pathogens. J Antimicrob Chemother 2012;67(2):255–268. DOI: 10.1093/jac/dkr466.
  14. Kaye KS, Rice LB, Dane AL, Stus V, Sagan O, Fedosiuk E, et al. Fosfomycin for injection (ZTI-01) versus piperacillin-tazobactam for the treatment of complicated urinary tract infection including acute pyelonephritis: ZEUS, a phase 2/3 randomized trial. Clin Infect Dis 2019;69(12):2045–2056. DOI: 10.1093/cid/ciz181.
  15. Apisarnthanarak A, Mundy LM. Use of high-dose 4-hour infusion of doripenem, in combination with fosfomycin, for treatment of carbapenem-resistant Pseudomonas aeruginosa pneumonia. Clin Infect Dis 2010;51(11):1352–1354. DOI: 10.1086/657249.
  16. Michalopoulos A, Virtzili S, Rafailidis P, Chalevelakis G, Damala M, Falagas ME. Intravenous fosfomycin for the treatment of nosocomial infections caused by carbapenem- resistant Klebsiella pneumoniae in critically ill patients: a prospective evaluation. Clin Microbiol Infect 2010;16(2):184–186. DOI: 10.1111/j.1469-0691.2009.02921.x.
  17. Miŕo JM, Entenza JM, Del Río A, Velasco M, Castañeda X, De La Mària CG, et al. High-dose daptomycin plus fosfomycin is safe and effective in treating methicillin-susceptible and methicillin-resistant Staphylococcus aureus endocarditis. Antimicrob Agents Chemother 2012;56(8):4511–4515. DOI: 10.1128/AAC.06449-11.
  18. Sumano LH, Ocampo CL, Gutierrez OL. Intravenous and intramuscular pharmacokinetics of a single-daily dose of disodium-fosfomycin in cattle, administered for 3 days. J Vet Pharmacol Ther 2007;30(1):49–54. DOI: 10.1111/j.1365-2885.2007.00812.x.
  19. Florent A, Chichmanian RM, Cua E, Pulcini C. Adverse events associated with intravenous fosfomycin. Int J Antimicrob Agents 2011;37(1):82–83. DOI: 10.1016/j.ijantimicag.2010.09.002.
  20. Gennari FJ. Disorders of potassium homeostasis. Hypokalemia and hyperkalemia. Crit Care Clin 2002;18(2):273–288, vi. DOI: 10.1016/s0749-0704(01)00009-4.
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