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      A Real-world Study on Prescription Pattern of Fosfomycin in Critical Care Patients

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          A bstract

          Background

          This study presents a real-world scenario for prescription pattern, efficacy, and safety data on the current clinical use of intravenous fosfomycin in critically ill patients in Indian settings.

          Patients and methods

          This was a retrospective cohort study conducted for a period of 10 months among critically ill patients admitted to hospital's critical care unit. The primary objective of the study was to analyze the prescription pattern of intravenous fosfomycin, and the secondary objective was to evaluate the safety profile and patient outcomes.

          Results

          A total of 309 patients were enrolled, and they were diagnosed with bacteremia (45.3%), pneumonia (15.85%), septic shock (14.24%), and urinary tract infections (UTI) (13.91%). The average dose of fosfomycin given was 11.7 ± 4.06 gm/day. The average duration of the therapy was 4.85 ± 3.59 days with a median duration of 4 days. Fosfomycin was given at 8 hourly dosing frequency to maximum (45.6%) cases. Hypokalemia was the most observed adverse event. The overall survival was seen in 55% of patients.

          Conclusion

          Our data suggest that UTI, infection caused by Escherichia coli, and a daily dose of >12 g were associated with better clinical outcomes. The overall survival of critically ill patients receiving fosfomycin was 55%.

          How to cite this article

          Zirpe KG, Mehta Y, Pandit R, Pande R, Deshmukh AM, Patil S, et al. A Real-world Study on Prescription Pattern of Fosfomycin in Critical Care Patients. Indian J Crit Care Med 2021;25(9):1055–1058.

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          Most cited references20

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          Fosfomycin.

          The treatment of bacterial infections suffers from two major problems: spread of multidrug-resistant (MDR) or extensively drug-resistant (XDR) pathogens and lack of development of new antibiotics active against such MDR and XDR bacteria. As a result, physicians have turned to older antibiotics, such as polymyxins, tetracyclines, and aminoglycosides. Lately, due to development of resistance to these agents, fosfomycin has gained attention, as it has remained active against both Gram-positive and Gram-negative MDR and XDR bacteria. New data of higher quality have become available, and several issues were clarified further. In this review, we summarize the available fosfomycin data regarding pharmacokinetic and pharmacodynamic properties, the in vitro activity against susceptible and antibiotic-resistant bacteria, mechanisms of resistance and development of resistance during treatment, synergy and antagonism with other antibiotics, clinical effectiveness, and adverse events. Issues that need to be studied further are also discussed.
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            Fosfomycin: Mechanism and Resistance.

            Fosfomycin, a natural product antibiotic, has been in use for >20 years in Spain, Germany, France, Japan, Brazil, and South Africa for urinary tract infections (UTIs) and other indications and was registered in the United States for the oral treatment of uncomplicated UTIs because of Enterococcus faecalis and Escherichia coli in 1996. It has a broad spectrum, is bactericidal, has very low toxicity, and acts as a time-dependent inhibitor of the MurA enzyme, which catalyzes the first committed step of peptidoglycan synthesis. Whereas resistance to fosfomycin arises rapidly in vitro through loss of active transport mechanisms, resistance is rarely seen during therapy of UTIs, seemingly because of the low fitness of the resistant organisms. Recently, interest has grown in the use of fosfomycin against multidrug-resistant (MDR) pathogens in other indications, prompting the advent of development in the United States of a parenteral formulation for use, initially, in complicated UTIs. Whereas resistance has not been problematic in the uncomplicated UTI setting, it remains to be seen whether resistance remains at bay with expansion to other indications.
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              Intravenous fosfomycin for the treatment of nosocomial infections caused by carbapenem-resistant Klebsiella pneumoniae in critically ill patients: a prospective evaluation.

              Intensive care unit (ICU)-acquired infections as a result of multidrug-resistant Gram-negative pathogens remain a serious problem in critically ill patients. Adult ICU patients who received intravenous fosfomycin were prospectively examined to assess its safety and effectiveness as an adjunct to the antimicrobial therapy of life-threatening infections caused by carbapenem-resistant Klebsiella pneumoniae. Fosfomycin was administered intravenously in 11 patients for treatment of hospital-acquired infections caused by carbapenem-resistant K. pneumoniae. Fosfomycin (2-4 g every 6 h) was administered in combination with other antibiotics. The mean +/- SD duration of treatment was 14 +/- 5.6 days. All patients had good bacteriological and clinical outcome of infection. All-cause hospital mortality was two out of 11 (18.2%) patients. No patient experienced adverse events related to the administration of fosfomycin. Intravenous fosfomycin may be a beneficial and safe adjunctive treatment in the management of life-threatening ICU-acquired infections caused by carbapenem-resistant K. pneumoniae.
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                Author and article information

                Journal
                Indian J Crit Care Med
                Indian J Crit Care Med
                IJCCM
                Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine
                Jaypee Brothers Medical Publishers
                0972-5229
                1998-359X
                September 2021
                : 25
                : 9
                : 1055-1058
                Affiliations
                [1 ]Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
                [2 ]Institute of Critical Care and Anesthesia, Medanta–The Medicity, Gurugram, Haryana, India
                [3 ]Department of Intensive Care, Fortis, Mumbai, Maharashtra, India
                [4 ]Department of Critical Care Medicine, BLK Super Speciality Hospital, Delhi, India
                [5 ]Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
                [6,8 ]Department of Global Medical Affairs, Glenmark Pharmaceutical Ltd, Mumbai, Maharashtra, India
                [7 ]Glenmark Pharmaceutical Ltd, Mumbai, Maharashtra, India
                Author notes
                Sagar Bhagat, Glenmark Pharmaceutical Ltd, Mumbai, Maharashtra, India, Phone: +91 9930553638, e-mail: sagar.bhagat@ 123456glenmarkpharma.com
                Author information
                https://orcid.org/0000-0002-8140-727X
                https://orcid.org/0000-0002-0888-4774
                https://orcid.org/0000-0002-5846-3708
                https://orcid.org/0000-0002-0149-727X
                https://orcid.org/0000-0001-5602-291X
                https://orcid.org/0000-0002-4937-3188
                https://orcid.org/0000-0002-0488-9359
                https://orcid.org/0000-0003-4346-9194
                Article
                10.5005/jp-journals-10071-23958
                8664030
                34963727
                77c709d5-6776-49e2-8cc1-3538f4488c40
                Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.

                © Jaypee Brothers Medical Publishers. 2021 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Categories
                Brief Research Communication

                Emergency medicine & Trauma
                critically ill adults,fosfomycin,retrospective study
                Emergency medicine & Trauma
                critically ill adults, fosfomycin, retrospective study

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