we are getting lot of paediatric patients with culture proven thyphoid fever resistant to cephalosporins
and sensitive to fosfomycin
can we use fosfomycin in these cases
and what should be the dose
Please look at this case report:
Kleine CE et al. Clin Infect Dis. 2017 Oct 30;65(10):1754-1756.
Successful Therapy of a Multidrug-Resistant Extended-Spectrum β-Lactamase-Producing and Fluoroquinolone-Resistant Salmonella enterica Subspecies enterica Serovar Typhi Infection Using Combination Therapy of Meropenem and Fosfomycin.
Kind regards!
meronium is every expansive drug in our country and in general is beyond the reach of general public
can fosfomycin and amikiccin be combined in ceftriaxone resistant cases
In a paper from 2011 (Turky) there was resistance against amikacin.
Why do you want to add fosfomycin for typhoid fever .I understand you are not talking of non typhoid salmonella bacteremia. For cephalosporin resistant typhoid illness you have other options of amoxicillin,amikacin,fluoraquinolones,TMP+SMX,chloramphenicol,carbapenems,and azithromycin.Fosfomycin has an approved indication for complicated UTI,and has been increasingly used in MDR/XDR/PDR infections and is to be avoided for typhoid fever.
sir we are getting lot of resistance to quinilones chorampenicol Cotrioxazole and cephalosporins
the only drugs sensitive are azomax and meronium
they are very expensive which are unaffordable to local populations
our patients have to buy themselves
You can use amocyclav.piperacillin+tazobactum (BL+BLI),amikacin,azithromycin, and carbapenems
sir amocyclav is resistant too
others like azomax and carbapenems
are very expensive and beyond reach of common man
Dear Mr. Javed,
you are facing a serious situation. I suggest you use azithromycin instead of fosfomycin whereever possible. The drug provides an intracellular mode of action and a long half-life time. The major problem of (uncombined) fosfomycin application is rapid development of resistance. Hence, you will perhaps loose your affordable "last resort" quicker than you may expact. The dosage is 100-max. 300mg per kg body-wheight devided into 3 applications per day. As xdr-typhoid fever is an emerging global threat, it may be a win-win situation if you could initiate a clinical trial evaluating the clinical efficacy of carbapenems for the treatment of typhoid fever. These data are urgently required. In the absence of other options I (personal opinion) would use fosfomycin as an individual cure trial, carefully document and share the results with the medical communety...
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