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Fosfomycin Not Noninferior to Comparators for Bacteremic UTI

Fosfomycin not noninferior to ceftriaxone or meropenem for bacteremic urinary tract infection due to multidrug-resistant E. coli in adults

FRIDAY, Jan. 14, 2022 (HealthDay News) — For patients with bacteremic urinary tract infections (bUTIs) due to multidrug-resistant (MDR) Escherichia coli, fosfomycin is not noninferior to comparators, with an increased rate of adverse event-related discontinuations, according to a study published online Jan. 13 in JAMA Network Open.

Jesús Sojo-Dorado, M.D., Ph.D., from the Universidad de Sevilla in Spain, and colleagues conducted a randomized trial at 22 hospitals from June 2014 to December 2018 involving 161 adults with bUTI due to MDR E. coli. Participants were randomly assigned to receive intravenous fosfomycin disodium (70 participants) or a comparator (ceftriaxone or meropenem if resistant; 73 participants).

The researchers found that 68.6 and 78.1 percent of the patients treated with fosfomycin and comparators, respectively, reached clinical and microbial cure (risk difference, −9.4 percentage points). Clinical or microbiological failure occurred among 14.3 and 19.7 percent of fosfomycin- and comparator-treated patients, respectively (risk difference, −5.4 percentage points). The rate of adverse event-related discontinuations was increased with fosfomycin versus comparators (8.5 versus 0 percent).

“Fosfomycin did not demonstrate noninferiority in the treatment of bUTI caused by MDR E. coli,” the authors write. “However, the data suggest that the drug is effective and may be considered among selected patients, particularly those without previous heart disease and with low risk of sodium overload-related problems.”

Several authors disclosed financial ties to the pharmaceutical industry.

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