Intravenous fosfomycin for the treatment of hospitalized patients with serious infections.

With the worldwide increase in the rates of antimicrobial resistance, antimicrobials with novel mechanisms of action are needed to fill a void in the antimicrobial armamentarium. Areas covered: Intravenous fosfomycin has been studied extensively in a wide variety of infections including cUTI, lower respiratory tract infection, bone and joint infections, endocarditis, meningitis, and bacteremia outside of the United States. This paper reviews the in vitro activity, pharmacokinetic properties, and clinical experience of intravenous fosfomycin in hospitalized patients with serious infections. Expert commentary: Drug resistant infections in hospitalized and critically ill patients are associated with high morbidity and mortality. Fosfomycin is an epoxide antimicrobial that acts by inhibiting cell wall synthesis earlier in the process compared to other classes of antimicrobial agents. Fosfomycin exerts bactericidal activity against a broad range of gram-negative and gram-positive pathogens, including extended-spectrum beta-lactamase- and carbapenemase-producing bacteria. Although an oral formulation of fosfomycin is approved by the United States (US) Food and Drug Administration for uncomplicated urinary tract infections, intravenous fosfomycin at a dose of 18 g/day is currently under clinical development for the treatment of complicated urinary tract infection (cUTI), including pyelonephritis in the US.