Ispitivanje učinkovitosti različitih shema doziranja fosfomicina u liječenju infekcija urinarnog trakta uzrokovanih sojevima E. coli i K. pneumoniae koje proizvode beta laktamaze proširenoga spektra Prospective controlled clinical trial of different fosfomycin dose regiments in the treatment of urinary tract infections caused by extended spectrum beta lactamase producing strains of E. coli and K. pneumoniae

摘要

In the era of rising antibiotic resistance rates, bacterial ESBL producing strains represent a major therapeutic problem. Hence, during the last years there is a growing interess in the investigation of older antibiotics like fosfomycin, especially due to its' oral route of administration and low cost. The main hypothesis of this doctoral thesis, in concordance with previous research, was that fosfomycin dose regimen in three divided doses during five days compared to a single dose, leads to better tretment outcomes of complicated urinary tract infections, in terms of both microbiological and clinical cure rates. It has also been assumed that fosfomycin is an effective treatment option for these infections. Both hypotheses have been confirmed by the results of this prospective clinical trial. Lastly, assumed extremly high in vitro susceptibility to fosfomycin of ESBL E. coli strains has been demonstrated, which enables empirical fosfomycin use, whereas in vitro sensitivity of ESBL K. pneumoniae strains was much lower. Future clinical research in this field should probably be directed to even more prolonged clinical courses of fosfomycin or the use of antibiotic combinations with different mechanisms of action, such as fosfomycin and nitrofurantoin.