Is fosfomycin as effective as claimed on MDR Gram-negative bacteria causing UTI? [Letter]

Geeta Singh,1 BR Singh21Independent Science Analyst, Bareilly, UP 243001, India; 2Head Division of Epidemiology, Indian Veterinary Research Institute, Bareilly, IndiaCorrespondence: Geeta SinghIndependent Science Analyst, 23A Vaibhav Suncity Vistaar, Bareilly, UP 243001, IndiaTel +91 9 917 020 7724Email geetasti45@gmail.comIn a recently published paper1 fosfomycin is claimed to be an effective antibiotic on Gram-negative bacteria (GNBs) causing urinary tract infections (UTIs) in Pondicherry in Southern India. Monotherapy of fosfomycin is not recommended due to chances for development of resistance during therapy is a serious concern2 therefore the authors suggested using fosfomycin with amoxyclav and nitrofurantoin.1 Researchers reported fosfomycin as the most effective antibiotic inhibiting 100% E. coli, 70% Klebsiella sp., and 50% Pseudomonas sp. and 40% Enterobacter sp. isolates from UTIs. Fosfomycin was also effective against extended-spectrum β-lactamases (ESBL), carbapenemase and AmpC1 producers. A recent report from Bareilly3, Northern India indicated E. coli as the most common bacteria associated with UTI infections both in humans and animals similar to the report from Pondicherry.1 However, the report from Northern India reported only that only 12.9% and 33.3% isolates of GNBs associated with UTIs in humans and animals were susceptible to fosfomycin. The study3 reported that only8.3% and 25% of E. coli isolates from UTI cases were susceptible to fosfomycin. The two studies1,3 concurred (Table 1) each other concerning the efficacy of meropenem and nitrofurantoin but contradicted each other for the susceptibility of E. coli isolates (Table 1) and other GNBs from UTIs to other antibiotics.View the original paper by Gopichand and colleaguesA Response to Letter has been published for this article