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The Potential Role of Fosfomycin in Neonatal Sepsis Caused by Multidrug-Resistant Bacteria

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Abstract

The broad-spectrum activity of fosfomycin, including against multidrug-resistant (MDR) strains, has led to renewed interest in its use in recent years. Neonatal sepsis remains a substantial cause of morbidity and mortality at a global level, with evidence that MDR bacteria play an increasing role. The evidence for use of fosfomycin in neonatal subjects is limited. We summarise current knowledge of the pharmacokinetics and clinical outcomes for the use of fosfomycin in neonatal sepsis and issues specific to neonatal physiology. While fosfomycin has a broad range of coverage, we evaluate the extent to which it may be effective against MDR bacteria in a neonatal setting, in light of recent evidence suggesting it to be most effective when administered in combination with other antibiotics. Given the urgency of clinical demand for treatment of MDR bacterial sepsis, we outline directions for further work, including the need for future clinical trials in this at-risk population.

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Authors and Affiliations

  1. Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George’s, University of London, Cranmer Terrace, London, SW17 0RE, UK

    Grace Li, Joseph F. Standing, Julia Bielicki, Paul T. Heath & Mike Sharland

  2. UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK

    Joseph F. Standing

  3. Antimicrobial Pharmacodynamics and Therapeutics, Department of Molecular and Clinical Pharmacology, University of Liverpool, Sherrington Building, Liverpool, L69 3GE, UK

    William Hope

  4. Division of Paediatric Pharmacology and Pharmacometrics, University of Basel Children’s Hospital (UKBB), Spitalstrasse 33, Postfach, 4031, Basel, Switzerland

    Julia Bielicki & John van den Anker

  5. Division of Clinical Pharmacology, Children’s National Health System, Washington, DC, USA

    John van den Anker

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  1. Grace Li
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  2. Joseph F. Standing
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Correspondence to Mike Sharland.

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Conflict of interest

Grace Li, Joseph F. Standing, Julia Bielicki, John van den Anker and Mike Sharland declare no conflicts of interest. William Hope has received research funding from Pfizer, Gilead, Astellas, iCuris, Amplyx, Spero Therapeutics and F2G, and has acted as a consultant and/or given talks for Pfizer, Basilea, Astellas, F2G, Nordic Pharma, The Medicines Company, Amplyx, Mayne Pharma, Spero Therapeutics, Auspherix, Cardeas and Pulmocide. Paul T. Heath acts as an investigator for clinical trials conducted on behalf of St George’s, University London and sponsored by vaccine manufacturers, and has participated in advisory boards but receives no personal payments from these activities.

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Li, G., Standing, J.F., Bielicki, J. et al. The Potential Role of Fosfomycin in Neonatal Sepsis Caused by Multidrug-Resistant Bacteria. Drugs 77, 941–950 (2017). https://doi.org/10.1007/s40265-017-0745-x

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