Selection of therapeutic agent for infections caused by resistant pathogens in pediatrics
Nikolaeva S.V., Grebennikova D.V., Gorelov A.V.
The rise of antibiotic resistance is an interdisciplinary challenge affecting physicians across all specialties. International studies indicate that resistance to reserve antibiotics among children in intensive care units (ICUs) has increased from 9% to 32% over the past two decades; furthermore, the inappropriate prescription of antibiotics for acute respiratory viral infections (ARVIs) in primary care settings further exacerbates the emergence of resistant strains. In this context, parenteral fosfomycin sodium has gained attention as an effective and safe therapeutic option. Its unique mechanism of action–inhibition of the MurA enzyme during the early stages of peptidoglycan synthesis–precludes cross-resistance with other classes of antibiotics. Its spectrum of activity encompasses both Gram-positive and Gram-negative microorganisms, including extended-spectrum beta-lactamase (ESBL) and carbapenemase producers, methicillin-resistant (MRSA), and vancomycin-resistant enterococci. The drug is approved for use starting from the neonatal period, exhibits a favorable safety (low-toxicity) profile, and demonstrates significant synergism when combined with beta-lactams, aminoglycosides, polymyxins, and glycopeptides. The treatment protocol involves incorporating fosfomycin into therapeutic regimens for severe infections caused by resistant pathogens, or using it empirically in cases where the risk of such pathogens is high. With the exception of urinary tract infections –where monotherapy is an option – the drug should be combined with other antibiotics to prevent the development of resistance and enhance therapeutic efficacy. The use of fosfomycin for treating severe infections in children is justified both by the lack of safe alternatives among reserve antibiotics and by its versatility, as it can be used for infections in virtually any anatomical site – a feature that is also advantageous from a pharmacoeconomic perspective.
In addition to its bactericidal action, fosfomycin exhibits immunomodulatory properties (such as the stimulation of phagocytosis and the modulation of cytokines), activity against bacterial biofilms, the ability to inhibit the adhesion of uropathogens, and a proven nephroprotective effect when used in combination with nephrotoxic agents. These properties expand the drug’s therapeutic potential, making it a valuable tool in combating infections caused by resistant pathogens in children of all age groups.
For citations: Nikolaeva S.V., Grebennikova D.V., Gorelov A.V. Selection of therapeutic agent for infections caused by resistant pathogens in pediatrics. Pharmateca. 2026;33(7):14-22. (In Russ.). DOI: https://dx.doi.org/10.18565/pharmateca.2026.7.14-22
Authors’ contribution: S.V. Nikolaeva — development of the article’s design concept, analysis and synthesis of literature data, writing and editing of the text. D.V. Grebennikova — analysis and synthesis of literature data. A.V. Gorelov — development of the article’s design concept and approval of the final version of the article for publication.
Conflicts of interest: The authors confirm that they have no conflicts of interest to declare.
Funding: The study was conducted without any sponsorship.
Keywords
fosfomycin
children
antibiotic resistance
multidrug resistance
intravenous administration
About the Authors
Svetlana V. Nikolaeva, Central Research Institute of Epidemiology, Russian Federal Service for Surveillance on Consumer Rights Protection and Human Well-Being, Moscow, Russia; https://orcid.org/0000-0003-3880-8112, nikolaeva008@list.ru (corresponding author)Darya V. Grebennikova, Pediatrician, Children’s City Polyclinic No. 30, Branch 5, Moscow, Russia
Aleksandr V. Gorelov, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow; Central Research Institute
of Epidemiology, Russian Federal Service for Surveillance on Consumer Rights Protection and Human Well-Being, Moscow; Russian University
of Medicine, Moscow, Russia
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