engleski

Cost effectiveness of fosfomycin use for uncomplicated urinary tract infections caused by microbial strains producing extended spectrum beta-lactamases

Introduction Antimicrobial Availability Task Force (AATF) in 2006 identified 6 most important multiresistant microbial pathogens: Acinetobacter baumannii, Aspergillus spp., Enterobacteriaceae producing extended spectrum betalactamases (ESBL), vancomycine resistant Enterococcus, MRSA and P. aeruginosa. Fosfomycin is an antibiotic that inactivates enolpyruvyl transferase, thus blocking condensation of uridine diphosphate- N-acetylglucosamine with phosphoenopyruvate and inhibiting bacterial cell wall synthesis. Standard therapy of urinary tract infections (UTI) caused by ESBL producing pathogens (38% of Kl. pneumoniae and 7% of E. coli hospital urinary isolates in Clinical Hospital Centre Zagreb in 2013.) relies on i.v. administration of carbapenem antibiotics (ertapenem, meropenem, imipenem + cilastatin, doripenem). In contrast, fosfomycin is given orally, in a single dose for uncomplicated urinary tract infections. It is well tolerated, in vitro resistance of common urinary pathogens as well as of ESBL producing strains is low and there is no cross resistance. Results and discussion Cost of 3 day course of carbapenem therapy of ESBL strain caused UTI can be projected as follows: ertapenem (140 €), meropenem (157€), imipenem+cilastatin (157€). If fosfomycin would be used, the projected cost for 1 day of therapy would be 10€ and 28€ for 3 day therapy (given as one dose every other day for 6 days), where longer administration is expected to increase effectiveness in comparison with single day fosfomycin regimen. Conclusion With reported therapy success rates between 80% and 95%, which is comparable to carbapenems, fosfomycin represents an extremely cost effective therapeutic option for uncomplicated UTI caused by ESBL producing strains.

fosfomycin; urinary tract infections; ESBL; cost effectiveness

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