Fosfomycin therapy for multiresistant Pseudomonas aeruginosa in cystic fibrosis.
BACKGROUND
Increasing resistance to standard antibiotics has been demonstrated in CF patients colonised by Pseudomonas aeruginosa. The antibiotic Fosfomycin has a unique mode of action against this organism, and may protect against aminoglycoside mediated renal and ototoxic effects. However, there is little published experience of this drug in IV form, and it is not licensed for use in the UK.


METHODS
In combination with other antibiotics, we used Fosfomycin to treat 30 pulmonary exacerbations in 15 adult CF patients colonised by P. aeruginosa, mainly multiresistant strains. All patients gave informed consent. We cultured sputum prior to treatment and measured spirometry, renal function, and symptoms before and after treatment, and recorded any side effects.


RESULTS
One patient developed nausea and Fosfomycin treatment was withdrawn. The remaining patients showed clinical resolution of their chest exacerbations (mean FEV1% predicted: pre 41.1 vs. post 49.4, P<0.001). Although there was a statistical increase in plasma urea (pre 3.9 mmol/l vs. post 4.3, P<0.03), this was still within the normal range. Plasma creatinine was unchanged.


CONCLUSIONS
This study shows that IV Fosfomycin is well tolerated by adult patients with CF and can be useful in the treatment of those colonised with multiresistant P. aeruginosa.
Mirakhur
A
A
Regional Adult CF Unit, The Cardiothoracic Centre, Liverpool, UK.
Gallagher
M J
MJ
Ledson
M J
MJ
Hart
C A
CA
Walshaw
M J
MJ
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D003550:Cystic Fibrosis / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D005578:Fosfomycin / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D011552:Pseudomonas Infections / Q000188:drug therapy; D011550:Pseudomonas aeruginosa / Q000187:drug effects*; D013183:Sputum / Q000382:microbiology
D000900:Anti-Bacterial Agents; D005578:Fosfomycin; D003404:Creatinine