Promising directions for the use of intravenous fosfomycin in children

Vlasova A.V., Kameneva T.R., Yakovlev S.V.

1) Department of Clinical Pharmacology, Morozov Children’s City Clinical Hospital, Moscow, Russia; 2) B.E. Votchal Department of Clinical Pharmacology and Therapy, Russian Medical Academy of Continuous Professional Education, Moscow, Russia; 3) OMD for Clinical Pharmacology, Research Institute for Healthcare Organization and Medical Management, Moscow, Russia; 4) Federal Research and Clinical Center of Resuscitation and Rehabilitation, Moscow, Russia; 5) Department of Clinical Pharmacology, S.S. Yudin City Clinical Hospital of the Moscow Healthcare Department, Moscow, Russia

Background: This review presents a brief overview of fosfomycin’s spectrum of activity, its efficacy in children, safety data, and information on ongoing clinical trials in children, which are defining more precise pharmacokinetic safety parameters across different age groups. These studies will provide additional information on expanding the indications for fosfomycin use in children.
Objective: Provision of a substantiated opinion on the role of fosfomycin in improving antimicrobial treatment outcomes for infections caused by resistant microorganisms in children, based on available evidence.
Conclusion: Fosfomycin in intravenous dosage form can be used to treat infections caused by resistant microorganisms as part of combination antimicrobial therapy. It is particularly important to note that in the adult population, increased survival was demonstrated for bacteremia caused by KPC carbapenemase-producing K. pneumoniae with the use of a combination of fosfomycin and ceftazidime avibactam compared with ceftazidime avibactam alone. Fosfomycin has demonstrated synergistic and additive activity in vitro in combination with various classes of antibiotics, particularly beta-lactams, daptomycin, polymyxins, and aminoglycosides. It should be preferred as part of combination antimicrobial therapy for the treatment of infections associated with invasive implantable devices due to its activity against biofilms. For the treatment of infections caused by microbes resistant to multiple antibiotics in children, high doses of intravenous fosfomycin (more than 200 mg/kg/day) should be used. Improving the safety profile of high-dose intravenous fosfomycin in children is possible with regular monitoring of electrolyte levels, especially in neonates and/or critically ill children with renal failure.

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About the Authors

Anna V. Vlasova, Dr. Sci. (Med.), Head of the Clinical Pharmacology Department, Morozov Children’s City Clinical Hospital, Moscow Healthcare Department; Associate Professor, B.E. Votchal Department of Clinical Pharmacology and Therapy, Russian Medical Academy of Continuous Professional Education; Leading Specialist, Clinical Pharmacology Department, Research Institute for Healthcare Organization and Medical Management, Moscow Healthcare Department, Moscow, Russia; annavlasova75@mail.ru, eLibrary SPIN 5248-6411, ORCID: https://orcid.org/0000-0001-5272-2070 (corresponding author)
T.R. Kameneva, Cand. Sci. (Med.), OMD for Clinical Pharmacology, Research Institute for Healthcare Organization and Medical Management; Federal Research and Clinical Center of Resuscitation and Rehabilitation, Moscow, Russia; tkameneva@fnkcrr.ru,
eLibrary SPIN: 8625-7540, ORCID: https://orcid.org/0000-0003-3957-5015
S.V. Yakovlev, Dr. Sci. (Med.), Professor, B.E. Votchal Department of Clinical Pharmacology and Therapy, Russian Medical Academy of Continuous Professional Education; Clinical Pharmacologist, S.S. Yudin City Clinical Hospital, Moscow Healthcare Department, Moscow, Russia;
antimicrob@yandex.ru, ORCID: https://orcid.org/0000-0001-7606-8708, eLibrary SPIN: 9313-1453

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