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Is fosfomycin as effective as claimed on MDR Gram-negative bacteria causing UTI? [Letter]

Authors Singh G, Singh BR

Received 26 July 2019

Accepted for publication 16 August 2019

Published 2 September 2019 Volume 2019:12 Pages 2711—2712

DOI https://doi.org/10.2147/IDR.S224769

Checked for plagiarism Yes

Editor who approved publication: Dr Eric Nulens

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Geeta Singh,1 BR Singh2

1Independent Science Analyst, Bareilly, UP 243001, India; 2Head Division of Epidemiology, Indian Veterinary Research Institute, Bareilly, India

Correspondence: Geeta Singh
Independent Science Analyst, 23A Vaibhav Suncity Vistaar, 
Bareilly, UP 243001, India
Tel +91 9 917 020 7724
Email [email protected]

In a recently published paper1 fosfomycin is claimed to be an effective antibiotic on Gram-negative bacteria (GNBs) causing urinary tract infections (UTIs) in Pondicherry in Southern India. Monotherapy of fosfomycin is not recommended due to chances for development of resistance during therapy is a serious concern2 therefore the authors suggested using fosfomycin with amoxyclav and nitrofurantoin.1 Researchers reported fosfomycin as the most effective antibiotic inhibiting 100% E. coli, 70% Klebsiella sp., and 50% Pseudomonas sp. and 40% Enterobacter sp. isolates from UTIs. Fosfomycin was also effective against extended-spectrum β-lactamases (ESBL), carbapenemase and AmpC1 producers. A recent report from Bareilly3, Northern India indicated E. coli as the most common bacteria associated with UTI infections both in humans and animals similar to the report from Pondicherry.1 However, the report from Northern India reported only that only 12.9% and 33.3% isolates of GNBs associated with UTIs in humans and animals were susceptible to fosfomycin. The study3 reported that only

8.3% and 25% of E. coli isolates from UTI cases were susceptible to fosfomycin. The two studies1,3 concurred (Table 1) each other concerning the efficacy of meropenem and nitrofurantoin but contradicted each other for the susceptibility of E. coli isolates (Table 1) and other GNBs from UTIs to other antibiotics.

View the original paper by Gopichand and colleagues

A Response to Letter has been published for this article

Dear editor

In a recently published paper1 fosfomycin is claimed to be an effective antibiotic on Gram-negative bacteria (GNBs) causing urinary tract infections (UTIs) in Pondicherry in Southern India. Monotherapy of fosfomycin is not recommended due to chances for development of resistance during therapy is a serious concern2 therefore the authors suggested using fosfomycin with amoxyclav and nitrofurantoin.1 Researchers reported fosfomycin as the most effective antibiotic inhibiting 100% E. coli, 70% Klebsiella sp., and 50% Pseudomonas sp. and 40% Enterobacter sp. isolates from UTIs. Fosfomycin was also effective against extended-spectrum β-lactamases (ESBL), carbapenemase and AmpC1 producers. A recent report from Bareilly3, Northern India indicated E. coli as the most common bacteria associated with UTI infections both in humans and animals similar to the report from Pondicherry.1 However, the report from Northern India reported only that only 12.9% and 33.3% isolates of GNBs associated with UTIs in humans and animals were susceptible to fosfomycin. The study3 reported that only 8.3% and 25% of E. coli isolates from UTI cases were susceptible to fosfomycin. The two studies1,3 concurred (Table 1) each other concerning the efficacy of meropenem and nitrofurantoin but contradicted each other for the susceptibility of E. coli isolates (Table 1) and other GNBs from UTIs to other antibiotics.

Table 1 Susceptibility patterns of Escherichia coli associated with urinary tract infections

Looking at both of the studies,1,3 we understand a wide variation in susceptibility (Table 1) of the bacteria from different regions and different patients causing similar infections. Thus, a generalization of observation should be avoided for suggesting or using antimicrobial chemotherapy, and more elaborate and continues surveys and monitoring the antimicrobial drug-resistance of important pathogens should be established and regularly published for proper guidance of the clinicians.

Disclosure

The authors report no conflicts of interest in this communication.

References

1. Gopichand P, Agarwal G, Natarajan M, et al. In vitro effect of fosfomycin on multi-drug resistant gram-negative bacteria causing urinary tract infections. Infect Drug Resist. 2019;12:2005–2013. doi:10.2147/IDR.S207569

2. Hardisson C, Villar CJ, Llaneza J, Mendoza MC. Prevalence and dispersion of plasmids conferring fosfomycin resistance in enterobacteria. Pathol Biol (Paris). 1984;32(7):755–758.

3. Singh BR 2019. Urinary tract infections: the most common causes and effective antimicrobials. Technical Report, UTI-1, Izatnagar: Indian Veterinary Research Institute. Available from: https://www.researchgate.net/publication/334544575_Urinary_tract_infections_The_most_common_causes_and_effective_antimicrobials. doi: 10.13140/RG.2.2.31538.56005/1

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