A multicentre, retrospective audit of fosfomycin use for urinary tract infections in Australian children and adolescents

Author:

Purcell Rachael1234,Yeoh Daniel56ORCID,Bowen Asha57ORCID,Britton Philip N89,Carr Jeremy P101112,Chen Ming13,Cheung Kaman10,Clark Julia1415,Irwin Adam1415ORCID,Lai Tony89ORCID,Lorenzen Ulrik13,Steer Andrew1316,Wen Sophie1415,Williams Phoebe8917,Yap Natalie110,Cooper Celia1318,Gwee Amanda1319

Affiliation:

1. Department of General Medicine, Royal Children's Hospital , Melbourne , Australia

2. Health Informatics Group, Murdoch Children's Research Institute , Melbourne , Australia

3. Department of Paediatrics, The University of Melbourne , Melbourne , Australia

4. Bioinformatics Group, Centre for Health Analytics, Royal Children's Hospital , Melbourne , Australia

5. Department of Infectious Diseases, Perth Children's Hospital , Perth , Australia

6. Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville , Victoria , Australia

7. Westfarmer Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia , Perth , Australia

8. Department of Infectious Diseases and Immunology, Sydney Children's Hospitals Network , Sydney , Australia

9. Sydney Institute for Infectious Diseases, The University of Sydney , Sydney , Australia

10. Department of Infection and Immunity, Monash Children's Hospital , Melbourne , Australia

11. Department of Paediatrics, Monash University , Melbourne , Australia

12. Department of Paediatrics, University of Oxford , Oxford , UK

13. Department of Infectious Diseases, Adelaide Women's and Children's Hospital , Adelaide , Australia

14. Infection Management and Prevention Service, Queensland Children's Hospital , Brisbane, Queensland , Australia

15. UQ Centre for Clinical Research, The University of Queensland , Brisbane, Queensland , Australia

16. Tropical Diseases Research Group, Murdoch Children's Research Institute , Melbourne , Australia

17. School of Public Health, The University of Sydney , Sydney , Australia

18. National Centre for Antimicrobial Stewardship , Adelaide , Australia

19. Infectious Diseases Group, Murdoch Children's Research Institute , Melbourne , Australia

Abstract

Abstract Background Urinary tract infections (UTIs) due to MDR organisms are increasingly common. The lack of paediatric data on efficacious antibiotics makes UTI treatment particularly challenging. Data on the efficacy of fosfomycin use for UTI in children are variable. Methods We conducted a retrospective audit of children aged 0–18 years who were treated with fosfomycin for UTI at seven tertiary paediatric hospitals in Australia over a 7 year period, from 2014 to 2020. Results Ninety-one children with a median age of 5 years (range 2 months to 18 years) received oral fosfomycin for UTI. The majority (57/91, 63%) had one or more comorbidity, with the most common being renal tract anomalies (24/91, 26%). Fifty-nine (65%) had febrile UTI, 14/91 (15%) had pyelonephritis and 1/91 (1%) was bacteraemic. A majority (80/91, 88%) of urinary cultures had an ESBL-producing Gram-negative pathogen isolated. Fosfomycin susceptibility was evident in all 80 isolates tested. For uncomplicated UTI, the most common dose in children aged <1, 1–12 and >12 years was 1, 2 and 3 g, respectively. For complicated UTI, doses of 2 and 3 g were most common. The median duration of fosfomycin administration was 5 days (range 1–82). Clinical cure was achieved in 84/90 (93%); the six with treatment failure had underlying comorbidities. Overall, 2/91 (2%) children experienced drug-related adverse effects comprising gastrointestinal symptoms in both, which resolved after treatment discontinuation. Conclusions Fosfomycin is well tolerated and associated with favourable treatment outcomes in children with UTI. Further research on the optimal dosing strategy is required.

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Pharmacology (medical),Pharmacology,Microbiology (medical)

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