Fosfomycin trometamol on par with other antibiotics for treatment of acute uncomplicated cystitis

The clinical and microbiological effectiveness of a single dose of oral fosfomycin trometamol is comparable to that of comparator antibiotics, as is safety, in women with confirmed or suspected acute uncomplicated cystitis, a recent study has shown. Use of fosfomycin trometamol is also associated with high patient compliance.

The investigators searched relevant databases using methods recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and assessed risk of bias and confounders. Clinical or microbiological success, defined as complete and/or incomplete resolution of symptoms at the end of treatment or microbiological eradication, was the primary endpoint.

Fifteen of the 539 articles identified met the eligibility criteria, comprising a total of 2,295 adult female patients. Of the studies, 14 were used for microbiological eradication analysis, 11 for clinical resolution analysis and 11 for safety outcome analysis.

In 14 randomized controlled trials (RCTs) comprising 2,052 patients, no difference was seen for microbiological eradication (odds ratio [OR], 1.03, 95 percent confidence interval [CI], 0.83–1.30; p=0.09). There was also no difference found for clinical resolution in all comparators combined in 11 RCTs comprising 1,976 patients (OR, 1.16, 95 percent CI, 0.91–1.49; p=0.13) or for safety outcome in 11 RCTs comprising 1,816 patients (OR, 1.17, 95 percent CI, 0.86–1.58; p=0.33).

Treatment-related adverse events that were reported for fosfomycin were mostly transient. In addition, patient compliance was better with the single dose fosfomycin therapy.