Fosfomicina trometamol: Una opción terapéutica válida en infecciones urinarias bajas

Walter Pedreira; Leonardo Anzalone; Marcelo Álvez; Alina Cafferatta

Authors

Walter Pedreira Universidad de la República, Facultad de Medicina, Cátedra de Bacteriología y Virología, Ex Prof. Agdo. Centro de Asistencia del Sindicato Médico del Uruguay, Sección Bacteriología del Laboratorio Clínico, Jefe. Microbiólogo
Leonardo Anzalone Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Departamento de Laboratorio Clínico, Prof. Adj. Cátedra de Bacteriología y Virología, Ex Prof. Adj.
Marcelo Álvez Médico posgrado en infectología
Alina Cafferatta Ministerio de Salud Pública, Administración de Servicios de Salud del Estado, Servicio de Salud de Asistencia Externa, Laboratorio de Asistencia Externa, Técnica

Keywords:

URINARY INFECTIONS, FOSFOMYCIN, TROMETAMOL

Abstract

Low urinary infection is a frequent pathology in women with good prognosis but high morbility.
Fosfomycin is a phosphoric acid derivative able to alter bacterial wall. Its activity comprises most of the uropathogenic agents with a 1% resistance in Escherichia coli, the most important uropathogen. Trometamol facilitates absorbtion of fosfomycin obtaining urinary concentration with therapeutic range lasting for three days after a 3 g dose.
Objectives: to determine the clinical/microbiological efficacy and safety of a single-3 g dose of fosfomycin trometamol (Fosfurol) in women with low non-complicated urinary infection.
Methods: a multicenter, randomized, non-comparative prospective study was undertaken. Fifty-four patients of public health centers and one private clinic presented symptoms of low urinary infection without taking antibiotics the previous 15 days. Urine was collected using reactives for abnormal elements and cultures for bactriuria. Patients with urinary infection received a single-3 g dose of fosfomycin trometamol. Strains were identified and sensitivity was studied. A clinical and microbiological follow up was done at the first and third week.
Results: germens were isolated as follow: 41 Escherichia coli, 4 Staphylococcus saprophyticus, 4 Proteus sp, 1 Enterococcus sp, 2 Klebsiella sp, 1 Streptococcus agalactiae and 1 Enterobacter sp. Only 3 strains of Staphylococcus saprophyticus and one strain of Klebsiella sp presented resistance in vitro.
Conclusions: low fosfomycin resistance in vitro altogether with high clinical-microbiological efficacy and tolerance to this antimicrobian indicate that it is a useful therapeutic in treating non-complicated urinary infections in women.

References

1) Sobel JD, Kaye D. Urinary Tract Infections. In:Mandell GL, Bennett JE, Dolin R (ed). Principles and Practice of Infectious Disease. 5 ed. New York:Churchill Livignstone, 2000:662-90.
2) Anzalone L, Cafferatta A, Pascale C, Javier A, Píriz N, Gallo J. Infección urinaria comunitaria:detección rápida en consultorio y planteos de terapéutica antibiótica empírica a utilizar. Congreso Panamericano de Infectología, 9, Congreso Panamericano de SIDA 1, Congreso Guatemalteco de Enfermedades Infecciosas 4, Ciudad de Guatemala. 1999:67.
3) Bailey RR. Review of published studies on single dose therapy of urinary tract infections. Infection 1990; 18 (Suppl 2):s53-6.
4) Caron F, Humbert G. Short-Term treatment of urinary tract infections:the french concept. Infection 1992; 20 (Suppl 4):s286- 90.
5) Bailey RR. Managment of lower urinary tract infections. Drugs 1993; 45(Suppl 3):s139-44.
6) Gialdroni Grassi G. Clinical Development of Fosfomycin Trometamol. Infection 1990; 18(Suppl 2):s57-s64.
7) Bergan T. Degree of absorption, pharmacokinetics of Fosfomycin Trometamol and duration of urinary antibacterial activity. Infection 1990; 18(Suppl 2):s65-s69.
8) Greenwood D. Fosfomycin Trometamol:activity in vitro against urinary tract pathogens. Infection 1990; 18(Suppl 2):s60-3.
9) Pedreira W, Anzalone L, Cafferatta A, Monroy F, Viola M. Estudio comparativo de la actividad in vitro de fosfomicina trometamol frente a agentes aislados de mujeres con infección urinaria no complicada. Rev Urug Patol Clín 2000; 32:20-3.
10) Smayevsky J, Rospide F, Incola F, Bantar C. Actividad comparativa in vitro de fosfomicina frente a microorganismos aislados de mujeres con infección urinaria no complicada. Centro de Educación Médica e Investigación Clínica, Buenos Aires, Argentina. Congreso Argentino de Microbiología 11, Buenos Aires, 1998:132.
11) Barry AL. Antibacterial spectrum of fosfomycin trometamol. J Antimicrob Chemother 1995; 35:228-30.
12) Garau M, Latorre A, Alonso-Sanz M. Fosfomicina:un antibiótico infravalorado en infecciones urinarias por Escherichia coli. Enferm Infec Microbiol Clin 2001; 19:462-6.
13) Patel SS, Balfour JA, Bryson HM. Fosfomycin trometamine. A review of its actibacterial activity, pharmacokinetic properties and therapeutic efficacy as a single dose oral treatment for uncomplicated lower urinary tract infections. Drugs 1997; 53(4):637-56.
14) Winkens RAG, Leffers P, Trienekens TAM, Stobberingh EE. The validity of urine examination for urinary tract infections in daily practice. Fam Pract 1995; 12(3):290-3.
15) Pels RJ, Bor DH, Woolhandler S, Himmelstein DU. Dipstick urinalysis screening of asymptomatic adults for urinary tract disorders. JAMA 1989; 262(9):1221-4.
16) Pezzlo M. Detection of urinary tract infections by rapid methods. Clin Microbiol Rev 1988; 1:268-86.
17) Stamm WE. Quantitative urine cultures revisited. Eur J Clin Microbiol 1984; 3:279-85.
18) Baron E, Piterson L, Finegold S. Urinary tract mechanisms. In:Bailey and Scotts. Diagnostic Microbiology, 10th ed. Philadelphia:Mosby, 1994:249-57.
19) National Committee for Clinical Laboratory Standars. Performance Standard for Antimicrobial Disk Susceptibility Test. Fifth Edition; Approved Estándar. Villanova:NCCLS 1993:(Document M2- A5, Vol 13, No 24).
20) Gelfand M, Jhonson R. Single-dose Fosfomycin Tromethamine:evaluation in the treatment of uncomplicated lower urinary tract infection. Adv Ther 1997; 14(2):49-63.
21) Moroni M. Monuril in lower uncomplicated urinary tract infections in adults. Eur Urol 1987; 13(Suppl I):101-4.
22) Stein GI. Single dose treatment of acute cistitis with fosfomycin tromethamine. Ann Pharmacother 1998; 32:2. 215-9.
23) Boerema JBJ, Willems ThC. Fosfomycine Trometamol single dose versus multiple dose Norfloxacin over seven days for uncomplicated UTI in general practice. Infection 1990; 18(Suppl 2):s80-8.
24) Jardin A. A general practitioner multicenter study:Fosfofomycin Trometamol single dose versus Pipemidic Acid multiple dose. Infection 1990; 18(Suppl 2):s89-93.
25) Reynaert J, Van Eyek D, Vandepitte J. Single dose Fosfomycin Trometamol versus multiple dose Norfloxacin over three days for uncomplicated UTI in general practice. Infection 1990; 18(Suppl 2):s77-88.
26) Neu HC. Fosfomycin trometamol versus amoxycillin - single dose:multicenter study of urinary tract infections. Chemotherapy 1990; 36( Suppl I ):19-23.
27) Stein GE. Comparison of single-dose fosfomycin and a 7 day course of nitrofurantoin in female patientes whit uncomplicated urinary tract infection. Clin Therap 1998; 1:864-72.
28) Selvaggi FP, Ditonno P, Traficante A, Battaglia M, Di Lorenzo V. Fosfomycin trometamol (Monuril) versus norfloxacin in single dose for adult female uncomplicated UTIs. Chemotherapy 1990; 36(Suppl I ):31-3.
29) Harvard Davis R, O' Dowd TC, Holmes W, Smail J, Slack RCB. A comparative double-blind randomizes study of single dose fosfomycin trometamol with trimetoprim in treatment of urinary tract infections in general practice. Chemotherapy 1990; 36(Suppl I):34-6.
30) Cooper J, Raeburn AL, Brumfitt W, Hamilton-Miller JMT. General practitioner study:fosfomycin trometamol versus amoxycillin clavulanate in acute urinary tract infections. Chemotherapy 1990; 36(Suppl I):24-6.
31) Elhanan G, Tabenkin H, Yahalom R, Raz R. Single-dose fosfomycin trometamol versus 5 - day cephalexin regimen for treatment of uncomplicated lower urinary tract infections in women. Antimicrob Agents Chemother 1994; 38:2612-4.
32) Crocchilo P. Single-dose fosfomycin trometamol versus multiple-dose cotrimoxazole in the treatment of lower urinary tract infections in general practice. Chemotherapy 1990; 36(Suppl I):37-40.
33) Naber KG, Thyroff-Friesinger U. Fosfomycin Trometamol versus Ofloxacin/Co- trimoxazole as single dose. Therapy of acute uncomplicated urinary tract infection in female:a multicentre study. Infection 1990; 18(Suppl 2):s70-6.
34) Naber K. The safety and tolerability of Fosfomycin Trometamol. Rev Contemp Pharmacother 1995; 6:63.
35) Bergan T, Di Mario F, Mastropaolo G, Naccarato R. Pharmacokinetics of fosfomycin and influencia of cimetidine and metroclopramide on the bioavailability of of fosfomycin trometamol. In:Neu H, Williams JD (eds):New trends in urinary tract infections. Karger:Basel, 1988:157-66.
36) Krcmery S, Horomec J, Demesova D. Treatment of lower urynary tract infection in pregnancy. Int J Antimicrob Agents 2001; 17:279-82.
37) Zinner S. Fosfomycine trometamol versus pipemidic acid in the treatment of bacteriuria in pregnancy. Chemotherapy 1990; 36(Suppl I):50-2.
38) Thoumsin H, Aghayan M, Lambotte R. Single dose Fosfomycin Trometamol versus multiple dose Nitrofurantoin in pregnant women with bacteriuruia:preliminary results. Infection 1990; 18(Suppl 2):s94-7.
39) Principi N, Corda R, Bassetti D, Varese LA, Peratoner L. Fosfomycin trometamol versus netilmicin in children's lower urinary tract infections. Chemotherapy 1990; 36(Suppl I):41-5.
40) Ferraro G, Ambrosi G, Bucci L, Palmieri G. Fosfomycin trometamol versus norfloxacin in the treatment of uncomplicated lower urinary tract infections of ederly. Chemotherapy 1990; (Suppl I):46-9.
41) Di Siverio F, Ferrone G, Carati I. Prophylactic chemotherapy with Fosfomycin Trometamol during transurethral surgery and urological manoeeuvres. Results of a multicenter study. Infection 1990; 18(Suppl 2):s98-102.
42) Baert I, Billiet I, Vandepitte J. Prophylactic chemotherapy with Fosfomycin trometamol versus placebo during transurethral prostatic resection. Infection 1990; 18(Suppl 2):s103-6.