Fosfomycin Trometamol in Patients with Renal Insufficiency and in the Elderly

Abstract

Single oral dose therapy with fosfomycin trometamol (FT) 3 g is recommended inthe treatment of uncomplicated urinary tract infection (UTI) not only in premenopausal,but also in postmenopausal elderly, otherwise healthy women. It can alsobe used as reapplication every 10 days for prophylaxis of recurrent uncomplicatedcystitis. FT 3 g has also been used with two oral doses of 3 g (on two consecutivedays) for perioperative prophylaxis in transurethral interventions or with three doses(every other day, three times) for treatment of complicated lower UTI includingmany elderly patients. The tolerance and safety in the patients above 65 yearsof age did not differ from younger ones. Therefore, there is also an indication toadminister oral FT 3g in adults above 65 years of age for treatment or prophylaxisof uncomplicated UTI.Patients with renal insufficiency up to a creatinine clearance of 20 ml/min can beexpected to have still sufficiently high urinary concentrations of fosfomycin, thattreatment of cystitis should be justified from pharmacokinetic/pharmacodynamicpoint of view. From preliminary clinical results there is also an indication to useoral FT 3 g in adults with renal insufficiency up to a creatinine clearance of 20 ml/min, with single dose for treatment of lower uncomplicated UTI with otherwisenormal urinary tract or with repeated doses (every second or third day accordingto the degree of renal insufficiency) for treatment of lower complicated UTI causedby fosfomycin susceptible pathogens resistant to other oral antimicrobial drugs