Fosfomycin and nitrofurantoin: classic antibiotics and perspectives

J Antibiot (Tokyo). 2021 Sep;74(9):547-558. doi: 10.1038/s41429-021-00444-z. Epub 2021 Jul 9.

Abstract

Antibiotics are essential molecules for the treatment and prophylaxis of many infectious diseases. However, drugs that combat microbial infections can become a human health threat due to their high and often indiscriminate consumption, considered one of the factors of antimicrobial resistance (AMR) emergence. The AMR crisis, the decrease in new drug development by the pharmaceutical industry, and reduced economic incentives for research have all reduced the options for treating infections, and new strategies are necessary, including the return of some traditional but "forgotten" antibiotics. However, prescriptions for these older drugs including nitrofurantoin and oral fosfomycin, have been based on the results of pioneer studies, and the limited knowledge generated 50-70 years ago may not be enough. To avoid harming patients and further increasing multidrug resistance, systematic evaluation is required, mainly for the drugs prescribed for community-acquired infections, such as urinary tract infections (UTI). Therefore, this review has the objective of reporting the use of two classic drugs from the nitrofuran and phosphonic acid classes for UTI control nowadays. Furthermore, we also explore new approaches used for these antibiotics, including new combination regimes for spectral amplification, and the prospects for reducing bacterial resistance in the fight against bacteria responsible for UTI.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / pharmacology*
  • Bacterial Infections / drug therapy
  • Bacterial Infections / microbiology
  • Community-Acquired Infections / drug therapy
  • Community-Acquired Infections / microbiology
  • Drug Development / trends
  • Drug Industry / trends
  • Drug Resistance, Multiple, Bacterial
  • Fosfomycin / administration & dosage
  • Fosfomycin / pharmacology*
  • Humans
  • Nitrofurantoin / administration & dosage
  • Nitrofurantoin / pharmacology*
  • Urinary Tract Infections / drug therapy
  • Urinary Tract Infections / microbiology

Substances

  • Anti-Bacterial Agents
  • Fosfomycin
  • Nitrofurantoin