Oral fosfomycin after carbapenems as de-escalating therapy in complicated urinary tract infections: A randomized controlled trial.
Int J Infect DisMay 30, 2026 (epub)
Kirun Angkanavisan, Boonsub Sakboonyarat, Chutchawan Ungthammakhun
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In 30 seconds
This randomized controlled trial evaluated the noninferiority of oral fosfomycin trometamol compared to continued carbapenem therapy in adults with complicated urinary tract infections (cUTIs) caused by third-generation cephalosporin-resistant Enterobacterales. The study found that clinical cure at day 7 was 98.4% in both groups, with fosfomycin significantly reducing hospital stay (7.9 vs 12.0 days).
Key findings
- Clinical cure at day 7 was 98.4% in both fosfomycin and carbapenem groups.
- Microbiological cure at day 7 was 100% with fosfomycin and 98.1% with carbapenem.
- Hospital stay was significantly shorter with fosfomycin at 7.9 days compared to 12.0 days with carbapenem.
Why it matters
The findings suggest that oral fosfomycin can be an effective step-down therapy for cUTIs, potentially reducing hospital stays and healthcare costs while maintaining treatment efficacy.