Practical information on using fosfomycin

Fosfomycin has activity against many strains of multidrug-resistant gram-negative bacteria, including isolates that produce extended-spectrum beta-lactamase enzymes (ESBLs), but is inactive against Pseudomonas aeruginosa.

In these guidelines, to reduce the risk of resistance to fosfomycin developing, oral fosfomycin is reserved for the treatment of multidrug-resistant urinary tract infections. Oral fosfomycin is not suitable for the treatment of pyelonephritis because it does not achieve adequate concentrations in kidney tissue.