fosfomycin and Gastroenteritis

Verocytotoxin producing Escherichia coli(VTEC) causes gastrointestinal infections worldwide. In at most 8% of the children in Japan who are infected with VTEC, hemolytic-uremic syndrome(HUS) develops soon after the onset of diarrhea. Treatment with antibiotics does not ameliorate VTEC infections, and in some studies from western countries, it has been associated with worse clinical outcomes. It was recently indicated in Japan that early administration of fosfomycin to the patients with VTEC infection can decrease the risk of HUS. Moreover, early administration of Synsorb-Pk with high affinity to verocytotoxin to the patients with gastrointestinal VTEC infection was demonstrated to decrease the incidence of very mild and mild HUS, but it did not decrease the risk of moderate and severe HUS. In the developing stage of HUS, intravenous administration of fluid and electrolytes should be determined cautiously to prevent hyponatremia and systemic congestion.

Topics: Animals; Electrolytes; Escherichia coli Infections; Escherichia coli O157; Fluid Therapy; Fosfomycin; Gastroenteritis; Hemolytic-Uremic Syndrome; Humans; Hyponatremia; Organosilicon Compounds; Risk; Trisaccharides

Forty-two infants, some premature, with enteropathogenic Esch. coli (EPEC) gastroenteritis were treated with an oral suspension of fosfomycin in a dose of 100 and 200 mg/kg per day. After the treatment there were 11 secondary clinical infections (6 reinfections and 5 relapses) which received a second treatment with fosfomycin. In total, 53 treatments were made with fosfomycin and in 92% of the cases there was both clinical and bacteriological cure. 93% of the EPEC strains were sensitive to fosfomycin in vitro, their minimum inhibitory concentrations being less than 64 mug/ml. The concentration of fosfomycin in blood and faeces was assayed by a diffusion plate microbiological method in a group of these children, showing that this antibiotic is partly absorbed and the rest eliminated in the faeces, where its concentration was found to be very high. Tolerance of the product was good, and there were neither toxic nor side effects.

Topics: Anti-Bacterial Agents; Clinical Trials as Topic; Escherichia coli Infections; Feces; Female; Fosfomycin; Gastroenteritis; Humans; Infant; Infant, Newborn; Infant, Premature, Diseases; Intestinal Absorption; Male; Microbial Sensitivity Tests

The experimental and clinical aspects such as difficulties in eradicating Salmonella, intracellular facultative bacteria, causing gastroenteritis were investigated. 1. In vitro study: In the present study using human polymorphonuclear neutrophilic leucocytes (PMNs), the author evaluated the eradicating effects of various drugs on Salmonella which can not be killed usually within PMNs. The author inferred that the phagocytic action was enhanced by fosfomycin (FOM); the transport of FOM to PMNs contributes greatly to the enhancement of the eradicating effects of FOM on Salmonella. This finding has been further supported by the morphological changes in the Salmonella in PMNs which were examined by electron microscopy. Further it was confirmed that various chemotherapeutic agents were affected by beta-lactamase in the feces. 2. Clinical Study: Some drugs were used for the treatment of Salmonella gastroenteritis to investigate the relationship between the drugs and eradication of the bacteria. The first was treated with FOM for 5 days after treatment with the other drugs for 5 days, the second was treated with FOM initially, and third was treated with the other drugs. The treatment in the first group was the most useful and the eradication rate of the bacteria was significantly high.

Topics: Anti-Bacterial Agents; Fosfomycin; Gastroenteritis; Humans; Microbial Sensitivity Tests; Neutrophils; Phagocytosis; Salmonella Infections; Salmonella typhimurium

The effect of calcium salt of fosfomycin in the treatment of 43 neonates suffering from acute gastroenterocolitis produced by enteropathogenic E. coli is evaluated. The minimal inhibitory concentration of these E. coli was, generally, lower than 128 mug/ml. Dosages of 150-200 mg/kg body weight/day were administered orally every 8 h. This treatment lasted for 4 days only. Clinical evolution was favorable in 38 (88%) babies and bacteriological evolution in 30 (70%). In eight cases a different flora to the initial was selected during the treatment with fosfomycin. None of the cases treated showed any toxic alteration attributed to the antibiotic.

Topics: Acute Disease; Administration, Oral; Anti-Bacterial Agents; Drug Evaluation; Escherichia coli Infections; Female; Fosfomycin; Gastroenteritis; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Male

A clinical test was carried out on 83 children suffering from infectious diarrhoeal processes who were treated with fosfomycin with the oral and paranteral route. Coproculture was carried out in all the children before the beginning of treatment and in 51 of them it was repeated at the end of treatment. Antibiograms were made on the isolated germs and their MIC to fosfomycin studied. Tolerance and secondary effects of the medicament were also studied. The study was considered insufficient in 13 patients so that the evaluation was based on 70, making 4 failures and 60 clinical cures. Administration of fosfomycin causes the eradication of serotypeable E. coli and is followed by an increase in the number of Proteus sp. and Klebsiella/Enterobacter. The sensitivity of the faecal flora to fosfomycin has been very high, except for the strains of Proteus sp. and Klebsiella/Enterobacter. The accumulative percentage of the MIC to fosfomycin of all the strains isolated shows that more than 75% of them are inhibited at concentrations under 32 mug/ml. Tolerance was good and no secondary effects were observed except for the sporadic rise in the SGPT of the children.

Topics: Acute Disease; Administration, Oral; Anti-Bacterial Agents; Bacterial Infections; Child, Preschool; Drug Evaluation; Fosfomycin; Gastroenteritis; Humans; Infant; Injections, Intramuscular