Fosfomycin effectively prevents drug-induced kidney injury in patients with cystic fibrosis.
25.10.2019
Fosfomycin effectively prevents drug-induced kidney injury in patients with cystic fibrosis.
Fosfomycin is one of the few "old" antibiotics experiencing a remarkable resurgence over the past decade. New therapeutic potentials of the drug continue to emerge, providing a strong rationale for its inclusion in treatment regimens for a variety of infections. Among its clinically significant features is its proven bactericidal activity against multidrug-resistant (MDR) pathogens, which expands its utility in treating severe and resistant infectious-inflammatory diseases.
Recently, results from a prospective randomized study were published, demonstrating the nephroprotective properties of fosfomycin. The drug was used as part of a combination therapy for one of the most challenging and aggressively progressing pulmonary infections in patients with cystic fibrosis. In such cases, the choice of antibiotics is predominantly based on microbiological sensitivity profiles, primarily targeting Pseudomonas aeruginosa.
Accordingly, the backbone of therapy for patients enrolled in the study consisted of an aminoglycoside antibiotic combined with polymyxin. It is well known that both aminoglycosides and polymyxins are nephrotoxic agents, with acute kidney injury being the most common adverse reaction. To date, there have been no effective methods established to prevent nephrotoxicity; thus, any strategy aimed at mitigating this complication is likely to be enthusiastically welcomed by the medical community.
Patients were divided into two groups. The control group received a standard intravenous regimen of tobramycin and colistin. The intervention group additionally received fosfomycin at a dose of 5 g three times daily. According to the study findings, in the group that received fosfomycin in addition to the aminoglycoside and polymyxin, concentrations of biochemical markers of acute tubular injury—N-acetyl-β-D-glucosaminidase (NAG), alanine aminopeptidase (AAP), and β2-microglobulin—were significantly lower than in the control group. These results from a robust, evidence-based study once again highlight the beneficial “non-antibiotic” effects of fosfomycin, particularly its potential as a nephroprotective agent.
Furthermore, fosfomycin exhibits several properties that enhance both its efficacy and safety: pronounced synergism with antibiotics from other classes against both Gram-positive and Gram-negative bacteria, inhibition of bacterial adhesion to epithelial cells, stimulation of phagocytosis, immunomodulatory effects, and the ability to penetrate bacterial biofilms. These biofilms, often found on mucosal surfaces (especially in patients with cystic fibrosis), catheters, and other implants, represent significant therapeutic challenges. The combination of these features positions fosfomycin as a valuable option for both pathogen eradication and the prevention of adverse effects and antibiotic resistance.
Based on the study:
Al-Aloul M., Nazareth D., Walshaw M. The renoprotective effect of concomitant fosfomycin in the treatment of pulmonary exacerbations in cystic fibrosis. Clin Kidney J. 2019 Oct; 12(5): 652–658.
Recently, results from a prospective randomized study were published, demonstrating the nephroprotective properties of fosfomycin. The drug was used as part of a combination therapy for one of the most challenging and aggressively progressing pulmonary infections in patients with cystic fibrosis. In such cases, the choice of antibiotics is predominantly based on microbiological sensitivity profiles, primarily targeting Pseudomonas aeruginosa.
Accordingly, the backbone of therapy for patients enrolled in the study consisted of an aminoglycoside antibiotic combined with polymyxin. It is well known that both aminoglycosides and polymyxins are nephrotoxic agents, with acute kidney injury being the most common adverse reaction. To date, there have been no effective methods established to prevent nephrotoxicity; thus, any strategy aimed at mitigating this complication is likely to be enthusiastically welcomed by the medical community.
Patients were divided into two groups. The control group received a standard intravenous regimen of tobramycin and colistin. The intervention group additionally received fosfomycin at a dose of 5 g three times daily. According to the study findings, in the group that received fosfomycin in addition to the aminoglycoside and polymyxin, concentrations of biochemical markers of acute tubular injury—N-acetyl-β-D-glucosaminidase (NAG), alanine aminopeptidase (AAP), and β2-microglobulin—were significantly lower than in the control group. These results from a robust, evidence-based study once again highlight the beneficial “non-antibiotic” effects of fosfomycin, particularly its potential as a nephroprotective agent.
Furthermore, fosfomycin exhibits several properties that enhance both its efficacy and safety: pronounced synergism with antibiotics from other classes against both Gram-positive and Gram-negative bacteria, inhibition of bacterial adhesion to epithelial cells, stimulation of phagocytosis, immunomodulatory effects, and the ability to penetrate bacterial biofilms. These biofilms, often found on mucosal surfaces (especially in patients with cystic fibrosis), catheters, and other implants, represent significant therapeutic challenges. The combination of these features positions fosfomycin as a valuable option for both pathogen eradication and the prevention of adverse effects and antibiotic resistance.
Based on the study:
Al-Aloul M., Nazareth D., Walshaw M. The renoprotective effect of concomitant fosfomycin in the treatment of pulmonary exacerbations in cystic fibrosis. Clin Kidney J. 2019 Oct; 12(5): 652–658.
