Magazine article Drug Topics

Once Is Enough

Magazine article Drug Topics

Once Is Enough

Article excerpt

New antibiotic for UTI offers convenient single dose

or many who grit their teeth at the thought of another doctor's visit triggered by the unpleasant onset of painful frequent, burning urination, relief is on the way. Monurol (fosfomycin trimethamine), developed by Forest Laboratories, St. Louis, Mo., has gained Food & Drug Administration approval for entrance into the market.

Fosfomycin trimethamine is a broadspectrum, bacteriocidal inhibitor of cell wall synthesis, indicated for treatment of uncomplicated urinary tract infections (UTI, acute cystitis) in women susceptible to strains of Escherichia coli and Enterococcus faecalis. The phosphonic acid derivative is structurally unrelated to other antibiotics and comes in the form of an orange-flavored powder delivering 3 gm of fosfomycin when mixed with water.

Forest Laboratories claims that the convenience of a one-time dose will boost compliance in patients apt to stop medication regimens at first signs of symptom relief. The long-acting antibiotic is said to achieve bacteriocidal activity in the urine within two to four hours of dosing, and sustain concentrations of active drug over three and a half days.

Arpi Kuyumjian, Pharm.D., infectious disease specialist at Hackensack Medical Center in New Jersey, reemphasized the importance of compliance. "Complications of untreated E. coli urinary tract infections can lead to E. coli bacteremia, pyelonephritis, and eventually sepsis in patients who miss, forget, ignore, or simply do not take their doses."

Fosfomycin was reported to be well tolerated in clinical trials. The most common adverse effects included diarrhea (10.4%) and headache (10.3%).

Studies to assess efficacy as compared with other agents are summarized in the accompanying table. Overall, fosfomycin appears to be similar to nitrofurantoin in clinical success rates and eradication of E. coli strains. A major concern expressed by Kuyumjian is the new agent's role in the treatment of ampicillin-resistant E. coli, which has been encountered quite often in hospitals. "Just recently, we performed an antibiogram in our own hospital, and E. coli was found to be more prevalent than staph. In fact, it was our No. …

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