Fosfomycin Therapy for Non-Complicated Lower Urinary Tract Infections during Pregnancy: Tanta University Experience

Objectives: To evaluate the efficacy, compliance, safety and economic cost for Fosfomycin trometamol and Nitofurantoin in uncomplicated lower urinary tract infections during pregnancy. Background: Nitofurantoin and Fosfomycin trometamol are recommended as the first-line agents for treatment of urinary tract infections (UTIs) in the latest guidelines endorsed by the Infectious Diseases Society of America (IDSA) and the European Society for Clinical Microbiology and Infectious Diseases (ESCMID). Fosfomycin is bactericidal and inhibits bacterial cell wall biogenesis and reduces bacterial adherence to uroepithelial cells. Fosfomycin has broad antibacterial activity against both Gram-positive and Gram-negative pathogens, as Escherichia coli, Escherichia faecalis, and various Gram-negatives like Citrobacter and Proteus. Both Nitofurantoin and Fosfomycin are category B in pregnancy. Patients and Methods: This study was conducted at Tanta University Hospitals in the period from June, 1, 2015 to January, 1, 2017. Patients were recruited from outpatient clinics of Obstetrics and Gynecology and Urology Departments presenting with asymptomatic bacteruria or cystitis. Patients were allocated randomly into 2 groups: group I (n = 50 cases) received Fosfomycin therapy and group II (n = 50 cases) received Nitofurantoin therapy (n = 50 cases). After treatment, evaluation of patient symptoms, organism count, patient compliance and cost of treatment were done. Results: The enrolled patients were suffering from lower urinary tract infections;asymptomatic bacteruria (17 cases) or cystitis (83 cases). Ten patients were excluded. The demographic data of included patients were not significant for both groups. Complete relief (100%) of symptoms 5 days after start of treatment was noticed in Fosfomycin group while improvement of symptoms after 5 day-treatment was noticed in 86.49% in Nitofurantoin group (p-value = 0.030). The side effects were recorded in 7 cases (18.42%) in Fosfomycin group compared to (35.14%) with significant difference in the reported side effects, (p-value = 0.003). Compliance was 38/38 (100%) in Fosfomycin group compared to 34/37 (91.89%) in Nitrofuantoin group (p-value = 0.001). Resistance was very minimal in Fosfomycin group where 1/38 case (2.63%) reported resistance for treatment compared to 8/37 cases (21.62%) in Nitofurantoin group (p-value = 0.001). Conclusion: Fosfomycin trometamine proved to be safe, effective, and has limited resistance. Moreover higher patient compliance and fewer side effects were recommending Fosfomycin to be a first choice drug for uncomplicated lower urinary tract infections during pregnancy at Tanta University.

Bacteriuria in patients with indwelling urethral catheter in Owerri Municipality,Nigeria

Objective:Bacteriuria in patients with indwelling urethral catheter in Owerri Municipality of Imo State,Nigeria was studied.Methods: A total of 500 early morning mid stream urine samples from patients admitted in different hospitals within the Municipality.The samples were microbiologically analysed using cultural methods on different isolation media.Results: A total of 220 isolates were identified.Identification tests showed the presence of Escherichia coli(10%),Staphylococcus aureus(9.0%),Klebsiella Sp.(7.0%),Proteus Sp.(5.8%),Streptococcus faecalis(4.0%),Pseudomonas aeruginosa(3.8%),Citrobacter Sp.(2.8%) and Enterobacter Sp.(1.6%).Samples obtained from patients aged 71-80 years had the highest incidence of bacteria.A total of 120(48.0%) of the isolates were obtained from female patients.Out of these 12.0% were identified as Escherichia coli.Result,further show that long duration catherized patients of up to 29 days and above have more bacteriuria infection than short term indwelling catheter.Conclusion: These findings have greatly implicated indwelling catheter as a major cause of bacteriuria in catheterized patients.