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Patient information: See related handout on UTIs in children, written by the author of this article. Guidelines regarding the diagnosis, treatment, and follow-up of urinary tract infections (UTIs) in children continue to evolve. Multicenter RSV-SBI Study Group of the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. Clinical and demographic factors associated with urinary tract infection in young febrile infants. Development of hypertension and uraemia after pyelonephritis in childhood: 27 year follow up. Anomalies of the distal ureter, bladder, and urethra in children: embryologic, radiologic, and pathologic features. Five-year study of medical or surgical treatment in children with severe vesico-ureteral reflux dimercaptosuccinic acid findings. Metaanalysis of urine screening tests for determining the risk of urinary tract infection in children Pediatr Infect Dis J. Moving from bag to catheter for urine collection in non-toilet-trained children suspected of having urinary tract infection: a paired comparison of urine cultures.
Short versus standard duration oral antibiotic therapy for acute urinary tract infection in children. Short-course versus conventional length antimicrobial therapy for uncomplicated lower urinary tract infections in children: a meta-analysis of 1279 patients. A meta-analysis of randomized, controlled trials comparing short- and long-course antibiotic therapy for urinary tract infections in children.
Oral versus initial intravenous therapy for urinary tract infections in young febrile children. Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials.
Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study. Is antibiotic prophylaxis in children with vesicoureteral reflux effective in preventing pyelonephritis and renal scars? Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood. Fosfomycin trometamol (fosfomycin tromethamine) [Monuril®, Monurol®, Monural®] is approved in numerous countries worldwide, mainly for the treatment of uncomplicated urinary tract infections (UTIs). JavaScript is currently disabled, this site works much better if you enable JavaScript in your browser. To describe the specific effects of available treatment options on symptom relief as well as on disease progression in relation to their potential side-effects.
Keywords: Alfuzosin, Disease progression, Doxazosin, Dutasteride, Finasteride, Symptom reduction, Tamsulosin, Terazosin. Correlation between prostate size and International Prostate Symptom Score (IPSS) is shown. LUTS are typically quantified by validated symptom scales such as the International Prostate Symptom Score (IPSS).
Improvements of International Prostate Symptom Score (IPSS) on treatment with various α1-adrenoceptor antagonists or with corresponding placebo are shown.
The use of thresholds of IPSS and Qmax values as inclusion criteria has important implications for the interpretation of treatment results.
Historically it has been assumed that ARBs act by antagonising the effect of endogenously released noradrenaline on prostate smooth-muscle cells, thereby reducing prostate tone and hence bladder outflow obstruction.
Indirect comparisons between the ARBs and more limited direct comparisons demonstrate that all of them have similar efficacy when applied in appropriate doses [9]. While alfuzosin, doxazosin, and terazosin are similar to each other chemically and with regard to a lack of α1-adrenoceptor subtype selectivity. The most frequent side-effects of ARBs are asthenia, dizziness, and (orthostatic) hypotension.
Despite a long-standing and widespread use of ARBs, an adverse event related to ocular function termed intraoperative floppy iris syndrome (IFIS) has been discovered only recently in the context of cataract surgery [15].
All ARBs are now available in formulations which are suitable for once-daily administration. Androgen effects on the prostate, similar to those on hair follicle cells, are mediated by the testosterone metabolite dihydrotestosterone, which is formed by the enzyme 5α-reductase [19].
Based on their differential mechanism of action, several studies have investigated possible benefits and risks of combining ARBs and ARIs.
Please find here videos of surgical procedures, lectures, operative techniques, case reports and expert's interviews in pediatric surgery. This site complies with the HONcode standard for trustworthy health information: verify here. The most common pathogen is Escherichia coli, accounting for approximately 85 percent of urinary tract infections in children. Although a somewhat less aggressive approach to evaluation is now recommended, it is important for primary care physicians to appropriately diagnose and treat UTIs in children.
Newborns with UTI may present with jaundice, sepsis, failure to thrive, vomiting, or fever.
The National Institute for Health and Clinical Excellence in the United Kingdom endorses incorporating specific strategies for urine testing based on the child's age (Figure 1).15 In this model, microscopy and urine culture should be performed in children younger than three years instead of dipstick testing.
The Urinary Tract Subcommittee of the American Academy of Pediatrics Committee on Quality Improvement. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.
Fosfomycin has good in vitro activity against common uropathogens, such as Escherichia coli (including extended-spectrum ?-lactamase-producing E. Colgan, University of Maryland, Department of Family and Community Medicine, Baltimore, MD, USA; A. However, the frail correlation between LUTS and prostatic enlargement or outflow obstruction have focused interest on the role of extraprostatic a-ARs in the pathogenesis of LUTS.
ARBs cause fast and persistent symptom relief but do not reduce prostate size or prevent progression as assessed (eg, by occurrence of urinary retention).
On the one hand, most patients primarily seek treatment to relieve their bothersome symptoms. This evidence has been collected under conditions which have implications for the interpretation of the data.
This is illustrated by the finding that even men with small prostates may have severe symptoms, whereas even patients with very large prostates have only mild to moderate symptoms in some cases (Fig. Data are baseline findings from consecutive patients consulting Jean de la Rosette over the course of 10 yr.
However, in the absence of pressure-flow studies, Qmax is not a pure indicator of bladder outlet resistance but rather, at least in part, also reflects bladder contractility.
Progression can be assessed based on prostate size (or its surrogate parameter, prostate-specific antigen [PSA] level), occurrence of complications such as acute urinary retention (AUR), and need to change over to surgical treatment, as well as symptom progression; combined end points have also been applied [3]. These criteria look remarkably similar across studies, possibly reflecting the effect of regulatory requirements; nevertheless, improvements in IPSS in the placebo arm of controlled studies differed between 9% and 33% (Fig. Contraction of the human prostate is mediated predominantly if not exclusively by α1A-adrenoceptors [7]. With regard to the side-effect profile, alfuzosin is more similar to tamsulosin than to doxazosin and terazosin. While a reduction of blood pressure may be beneficial in hypertensive patients, at least some of the observed asthenia and dizziness can be attributed to decreasing the blood pressure.
A systematic review has concluded that ARBs do not adversely affect libido; if anything, they have a small beneficial effect on erectile function, but in some cases they can cause abnormal ejaculation [17]. To minimise adverse events, it is recommended that dose titration be used on initiation of treatment with doxazosin or terazosin, whereas this is not required for alfuzosin or tamsulosin. Two isoforms of this enzyme exist: Finasteride inhibits only one of these effects, whereas dutasteride inhibits both with similar potency. Symptom reduction by ARIs depends on prostate size and may not exceed that of placebo in patients with a gland of <40ml [21]. They include reduced libido, erectile dysfunction, and, less frequently, abnormal ejaculation [20]. In the absence of direct comparative studies of adequate size, it appears that PDE inhibitors are as effective as ARBs in reducing IPSS but apparently lack effects on Qmax. While the main strength of ARBs is symptom reduction, the main strength of ARIs is prevention of disease progression on long-term use. Academic Medical Centre, Department Pharmacology and Pharmacotherapy, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands. All streaming videos are charge-free, however, for users interested in our high quality videos (480p), they are available for purchase and download on WeBSurg HD. Renal parenchymal defects are present in 3 to 15 percent of children within one to two years of their first diagnosed urinary tract infection. Some underlying etiologies, including renal scarring and renal disease, can lead to considerable morbidity later in life.Acute UTIs are relatively common in children.
In infants and young children, typical signs and symptoms include fever, strong-smelling urine, hematuria, abdominal or flank pain, and new-onset urinary incontinence. Evidence-based care guideline for medical management of first urinary tract infection in children 12 years of age or less. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.
However, the exact mode and sites of action of the ?1-AR antagonists used for the treatment of LUTS have not been established. In this regard, storage symptoms are considered to be more bothersome than voiding symptoms. Therefore, it is useful to first look at some of the implications of the methods that have been used in the past.
Moreover, it should be noted that four of the seven IPSS items relate to voiding and postvoiding symptoms, whereas only three of the items relate to storage symptoms. Accordingly, neither Qmax baseline values nor their improvement on treatment correlate well with those of the IPSS or bladder outlet resistance [1]. The definition of progression has major implications on how effective specific treatments are considered. Of note, more recent studies not requiring a certain Qmax as an inclusion criterion have reported much less (if any) Qmax improvement in the placebo arm than in earlier studies [5]. ARBs, however, have only little effect on urodynamically determined outflow resistance [8], and treatment-associated improvement of LUTS correlated only poorly with those of obstruction [1]. While different formulations of a given drug can differ in their pharmacokinetic behaviour and, perhaps, in their tolerability profile, the overall clinical impact of the different formulations is modest. The mechanisms underlying such differential tolerability are not fully clear, but they may involve partitioning into lower urinary tract tissues by alfuzosin and tamsulosin. Whether this reflects a greater risk with tamsulosin than with other ARBs, or rather its greater use, remains to be determined, particularly because the ratio between doses yielding ocular effects and those acting on the lower urinary tract, at least in experimental animals, are similar for all ARBs [16]. While this has long been assumed to reflect retrograde ejaculation, more recent data demonstrate that it rather is due to a (relative) anejaculation.
Based on rapid onset of action, ARBs, specifically those not requiring dose titration, can be considered for intermittent use in patients who do not require long-term treatment due to the fluctuating intensity of their symptoms. Their effect on the circulating PSA level needs to be considered in the use of this parameter for prostate cancer screening. A 4-yr study, however, has demonstrated additive effects of both drug types on a combined end point of disease progression, reflecting that ARIs prevent the development of urinary retention, whereas ARBs prevent symptom progression [3].
Among the possible candidates, intraprostatic botulinum toxin administration is of interest because it apparently shrinks the prostate to a major extent [27]. Most of these studies have been performed in addition to studies of ARB use, and they generally have yielded positive results.

There is little evidence for differences in treatment efficacy in either group, but the ARBs alfuzosin and tamsulosin have better tolerability. Clinical signs and symptoms of a urinary tract infection depend on the age of the child, but all febrile children two to 24 months of age with no obvious cause of infection should be evaluated for urinary tract infection (with the exception of circumcised boys older than 12 months). School-aged children may have symptoms similar to adults, including dysuria, frequency, or urgency.
A single oral dose of fosfomycin trometamol 3 g (the approved dosage) achieves high concentrations in urine. ARIs reduce prostate size and prevent disease progression, but symptom reduction occurs more slowly and is less pronounced than with ARBs.
Moreover, storage symptoms in particular can persist even after successful deobstruction, and recent data show that treatment effects on obstruction only poorly correlate with those on LUTS [1]. This means that reported data from randomised studies systematically underestimate medical treatment results [6]. Naftopidil and more recently silodosin are used in some countries, but only limited clinical data are available on these two drugs; therefore, they will not be discussed in detail in this article.
In real-life, open-label studies (lacking a run-in period), IPSS improvements of up to 50% and Qmax increases of up to 40% have been reported [11]. Moreover, factors such as subtype selectivity (tamsulosin) and smooth pharmacokinetic profiles of certain formulations may also contribute to the tolerability profile of specific drugs.
It appears prudent not to initiate ARB treatment prior to an already planned cataract surgery. ARIs cause a reduction of prostate size by about 20%, and they reduce circulating PSA levels by about 50% [20]. Most direct comparative studies with ARBs have demonstrated that ARIs reduce symptoms not only more slowly but also less effectively [3]. Interestingly, ARIs can reduce blood loss during transurethral prostate surgery, possibly due to their effects on prostatic vascularisation [24]. It may be attractive because it also addresses possibly coexisting erectile dysfunction, but in most countries, it is priced much higher than ARBs or ARIs. Moreover, there have been no major elevations of postvoiding residual urine, indicating a limited risk for urinary retention [28]. Based on these data, it appears plausible that the question of whether to use ARBs, ARIs, or their combination should mainly be driven by the specific treatment goals of a given patient. Treatment satisfaction of patients with lower urinary tract symptoms: randomised controlled trials vs. A review of the clinical efficacy and safety of 5α-reductase inhibitors for the enlarged prostate.
Lower urinary tract symptoms suggestive of benign prostatic obstruction – what's the long-term effectiveness of medical therapies?. Boys are at increased risk of UTI if younger than six months, or if younger than 12 months and uncircumcised. Radionuclide cystography or voiding cystourethrography is effective for screening and grading vesicoureteral reflux, but involves radiation exposure and catheterization. Finally, treatment results in a large recent study in which classical inclusion criteria of earlier BPH and overactive bladder (OAB) trials were applied, differed considerably from those reported previously in a consistent manner when only BPH or only OAB criteria were used [2]. Additionally, the presence of a given symptom does not necessarily mean that it bothers the patient. While both ARIs and ARBs prevented AUR in short studies (≤1 yr), in longer studies, which better reflect the remaining life expectancy of patients, only ARIs were effective [3]. This also overemphasises the difference in efficacy among medical treatments and surgical treatments, which lack a run-in period. The α1-adrenoceptors in blood vessels, in other nonprostatic smooth-muscle cells, and in the central nervous system are considered as mediators of side-effects associated with ARB treatment, and all three receptor subtypes may be involved. The limited available evidence, however, does not suggest that they differ substantially from the other ARBs.
While improvements take a few weeks to fully develop, statistically significant efficacy over placebo has already been demonstrated within hours to days. This includes not only antihypertensive drugs such as β-adrenoceptor antagonists, diuretics, Ca-channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor antagonists but also phosphodiesterase (PDE) inhibitors used in the treatment of erectile dysfunction [14]. Existing ARBs treatment should be stopped prior to eye surgery, but how long prior to surgery remains unclear. While abnormal ejaculation has been observed more frequently with tamsulosin than with other ARBs, such difference did not reach statistical significance in studies directly comparing it with alfuzosin, and it is not associated with reductions in overall sexual function [17].
The exception is a recent 2-yr study in patients with very large prostates where dutasteride reduced symptoms as much or even more than tamsulosin [4].
Given the greater side-effects and treatment costs of combination treatment, it remains to be determined for which patients it indeed is beneficial. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. The effects of dutasteride, tamsulosin and combination therapy on lower urinary tract symptoms in men with benign prostatic hyperplasia and prostatic enlargement: 2-year results from the CombAT study. A meta-analysis of the vascular-related safety profile and efficacy of α-adrenergic blockers for symptoms related to benign prostatic hyperplasia. In vivo studies on the effects of α1-adrenoceptor antagonists on pupil diameter and urethral tone in rabbits. Prostate volume predicts outcome of treatment of benign prostatic hyperplasia with finasteride: meta-analysis of randomized clinical trials. The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Does anticholinergic medication have a role in treating men with overactive bladder and benign prostatic hyperplasia?. Although voiding cystourethrography is suggested for either girls or boys, radionuclide cystography is suggested only for girls because voiding cystourethrography is needed for adequate anatomic imaging of the urethra and bladder in boys. Due to differential modes of action, the combination of ARBs and ARIs has additive effects against combined end points of disease progression, but they also have additive side-effects.
Nevertheless, most existing treatment studies have not vigorously excluded LUTS causes other than BPH, particularly a concomitant OAB. In contrast, symptom progression was more effectively prevented by ARBs than by ARIs [3], unless a very large prostate was present at baseline [4]. Second, the improvements during the single-blind run-in lead to an overestimation of the contribution of active drug to the overall treatment results.
When efficacy is expressed as a percentage of improvement in IPSS, it appears to be similar in patients with mild, moderate, and severe symptoms [11].
Of note, the occurrence of IFIS complicates cataract surgery and makes it technically more demanding for the ophthalmologist, but there are no reports that it puts the health of the patient at risk. In contrast, ARIs (but not ARBs) reduce disease progression as defined by AUR or progression to surgery [3] and [22]. It appears plausible to assume that patients at a high risk of progression may specifically benefit from combination treatment. In this regard, the most informative study has compared a muscarinic antagonist, an ARB, and their combination to placebo [2].
State of the art on the efficacy and tolerability of α1-adrenoceptor antagonists in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Comparison of tamsulosin efficacy in subgroups of patients with lower urinary tract symptoms. Treatment for lower urinary tract symptoms suggestive of benign prostatic hyperplasia: the cardiovascular system.
A renal cortical scan (also called scintigraphy or DMSA scan) uses technetium and is effective for assessing renal scarring, but requires intravenous injection of radioisotope.Long-term outcome studies have not been performed to determine the best initial imaging study in children diagnosed with UTI.
Fluoroquinolones may be useful when infection is caused by multidrug-resistant pathogens for which there is no safe and effective alternative, parenteral therapy is not feasible, and no other effective oral agent is available.
Single-dose fosfomycin trometamol was generally well tolerated, with gastrointestinal adverse events (e.g. While several other treatment options are currently under investigation, none are sufficiently well documented to allow treatment recommendations. While the relative importance of these two goals may differ among patients, any treatment should have as few side-effects as possible, particularly if comorbidities and associated comedications in many patients can affect the choice of optimal treatment. Accordingly, both ARBs and ARIs were effective against combined end points, and that is where their combination may have specific benefits [3]. All of the above implications of study design need to be considered in the interpretation of the reported study outcomes. Prevention of disease progression by ARIs is already detectable with prostate sizes considerably <40ml [23]. Alternatively, patients at a high risk of progression may retain a large absolute risk of progression, even in the presence of a considerable reduction of relative risk. Do α1-adrenoceptor antagonists improve lower urinary tract symptoms by reducing bladder outlet resistance?. Sipahi, Department of Infectious Diseases and Clinical Microbiology, Ege University Faculty of Medicine, Bornova Izmir, Turkey. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. ARBs do not reduce prostate size and do not prevent AUR in multiyear studies [3]; accordingly, some patients require a change to a surgical treatment approach over time.
Accordingly, each of the two drugs in isolation did less well compared to placebo than may have been expected in their classical indication, but the combination of both showed remarkable efficacy. Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder. Long-term risk of re-treatment of patients using α-blockers for lower urinary tract symptoms. Transurethral prostate resection and bleeding: a randomized, placebo controlled trial of the role of finasteride for decreasing operative blood loss.
Prophylactic antibiotics do not reduce the risk of subsequent urinary tract infections, even in children with mild to moderate vesicoureteral reflux.
A negative leukocyte esterase result greatly reduces the likelihood of UTI, whereas a positive nitrite result makes it much more likely; the converse is not true, however. This strategy avoids bladder catheterization with cystography and minimizes radiation exposure if the results of the scan are normal. In conclusion, single-dose fosfomycin trometamol is an important option for the first-line empirical treatment of uncomplicated lower UTIs. Additional options, which are currently undergoing clinical evaluation, will be discussed briefly. While the efficacy of ARBs against symptoms appears to be maintained over at least 4 yr in controlled studies [3], the rate of changing to surgical treatment in real life may be considerably higher [13]; the reasons for this discrepancy are not well understood. Dipstick tests for blood and protein have poor sensitivity and specificity in the detection of UTI and may be misleading. Ultrasonography, cystography, and a renal cortical scan should be considered in children with urinary tract infections. If intravenous therapy is used, single daily dosing with aminoglycosides is safe and effective.
Surveillance study in Europe and Brazil on clinical aspects and Antimicrobial Resistance Epidemiology in Females with Cystitis (ARESC): implications for empiric therapy. Degree of absorption, pharmacokinetics of fosfomycin trometamol and duration of urinary antibacterial activity. Other antimicrobials of interest in the era of extended-spectrum ?-lactamases: fosfomycin, nitrofurantoin and tigecycline.
Single-dose fosfomycin tromethamine: evaluation in the treatment of uncomplicated lower urinary tract infection. In vitro activity of fosfomycin against enterobacterial urinary isolates producing extended-spectrum ?-lactamase (ESBL) [abstract no. Evaluation of in vitro activity of fosfomycin tromethamin against Escherichia coli and Klebsiella species recovered from community- and hospital-acquired uirinary tract infections in Turkey [abstract no.

Prevention of in vitro emergence of fosfomycin resistance in methicillin-resistant Staphylococcus aureus (MRSA) [abstract no. In vitro susceptibility of quinolone-resistant Escherichia coli isolates with and without producing extended-spectrum beta-lactamase to fosfomycin trometamol [abstract plus poster]. In vitro activity of fosfomycin against urinary tract isolates of Escherichia coli isolated from patients across Canada from 2010 to 2013 [abstract].
Fosfomycin: evaluation of the published evidence on the emergence of antimicrobial resistance in Gram-negative pathogens.
In vitro activity of fosfomycin against extended-spectrum-?-lactamase-producing Escherichia coli and Klebsiella pneumoniae: comparison of susceptibility testing procedures. Interpretive criteria and quality control parameters for determining bacterial susceptibility to fosfomycin tromethamine.
Antimicrobial susceptibilities of urinary extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae to fosfomycin and nitrofurantoin in a teaching hospital in Taiwan.
In vitro activity of fosfomycin and other antimicrobials against uropathogenic Escherichia coli and Klebsiella pneumoniae at a tertiary care center in Lebanon. In vitro susceptibility of enterococci strains isolated from urine samples to fosfomycin and other antibiotics.
Fosfomycin: an oral agent for urinary infection caused by extended spectrum beta-lactamase producing organisms. Is there a rise in resistance rates to fosfomycin and other commonly used antibiotics in Escherichia coli-mediated urinary tract infections?
Evaluation of the in vitro activity of fosfomycin tromethamine against Gram-negative bacterial strains recovered from community- and hospital-acquired urinary tract infections in Turkey. Antimicrobial susceptibility of clinical Escherichia coli isolates from uncomplicated cystitis in women over a 1-year period in Spain. In vitro activity of fosfomycin against ciprofloxacin-resistant or extended-spectrum ?-lactamase-producing Escherichia coli isolated from urine and blood.
In vitro susceptibility of community-acquired urinary tract pathogens to commonly used antimicrobial agents in Spain: a comparative multicenter study (2002–2004). Fosfomycin tromethamine as second agent for the treatment of acute, uncomplicated urinary tract infections in adult female patients in The Netherlands?
Microbiological basis for the use of fosfomycin trometamol as single-dose therapy for simple cystitis. Pharmacokinetic and pharmacodynamic aspects of antimicrobial agents for the treatment of uncomplicated urinary tract infections. At atlas of photographs illustrating the effects of fosfomycin trometamol on bacterial adhesiveness; 2006.
Effect of fosfomycin trometamol on bacterial adhesion in comparison with other chemotherapeutic agents.
In vitro activity of fosfomycin against Gram-negative urinary pathogens and the biological cost of fosfomycin resistance. Synergistic effects of aminoglycosides and fosfomycin on Pseudomonas aeruginosa in vitro and biofilm infections in a rat model.
Treatment of Pseudomonas aeruginosa biofilms with a combination of fluoroquinolones and fosfomycin in a rat urinary tract infection model. Purification of a glutathione S-transferase that mediates fosfomycin resistance in bacteria.
Etiology of community-acquired lower urinary infections and antimicrobial resistance of Escherichia coli: a national surveillance study [in Spanish].
Changes in the antimicrobial susceptibility of Escherichia coli isolates from nosocomial versus community-acquired urinary tract infections [in Spanish]. Antibiotic resistance transformation in community-acquired urinary infections [in Spanish].
Microorganisms isolated from outpatient urine samples and antimicrobial susceptibility over a 12-year period [in Spanish]. Urinary tract infections in women aged 15 to 65 years in open-care practice: monitoring of Escherichia coli sensitivity to fosfomycin treatment on the basis of the previous history [in French]. CTX-M-15-producing urinary Escherichia coli O25b-ST131-phylogroup B2 has acquired resistance to fosfomycin. Increasing prevalence of fosfomycin resistance in extended-spectrum-?-lactamase-producing Escherichia coli urinary isolates (2005–2009–2011) [in Spanish].
Parallel increase in community use of fosfomycin and resistance to fosfomycin in extended-spectrum ?-lactamase (ESBL)-producing Escherichia coli.
In-vitro susceptibility of quinolone-resistant clinical isolates of Escherichia coli to fosfomycin trometamol. Antimicrobial susceptibility of multidrug-resistant (MDR) and extensively drug-resistant (XDR) Enterobacteriaceae isolates to fosfomycin. Fosfomycin for the treatment of multidrug-resistant, including extended-spectrum ?-lactamase producing, Enterobacteriaceae infections: a systematic review.
Experience with fosfomycin for treatment of urinary tract infections due to multidrug-resistant organisms.
Fosfomycin activity versus carbapenem-resistant Enterobacteriaceae and vancomycin-resistant Enterococcus, Detroit, 2008–10.
Fosfomycin distribution in the lower urinary tract after administration of fosfomycin trometamol salt.
Concentrazioni nel siero e nel tessuto prostatico di fosfomicina con fosfomicina-trometamolo, nuovo derivato della fosfomicina con elevata biodisponibilita per somministazione orale. Urinary concentrations of fosfomycin after a single 3 g dose of fosfomycin to elderly nursing-home patients. Pharmacokinetics of fosfomycin and influence of cimetidine and metoclopramide on the bioavailability of fosfomycin trometamol.
Comparative pharmacokinetics of fosfomycin trometamol, sodium fosfomycin and calcium fosfomycin in humans. A randomized comparative study of single-dose fosfomycin and 5-day ciprofloxacin in female patients with uncomplicated lower urinary tract infections. Randomized clinical trial of short-course norfloxacin vs single dose fosfomycin for uncomplicated UTI in region with 10% resistance level of uropathogenic E. Isolation of fluoroquinolone-resistant rectal Escherichia coli after treatment of acute uncomplicated cystitis. Pilot study of fosfomycin trometamol compared with trimethoprim- sulfamethoxazole for acute uncomplicated cystitis in women [abstract no.
Is single-dose fosfomycin trometamol a good alternative for asymptomatic bacteriuria in the second trimester of pregnancy?
Fosfomycin in a single dose versus a 7-day course of amoxicillin-clavulanate for the treatment of asymptomatic bacteriuria during pregnancy.
Comparison of single-dose and multiple-dose antibiotics for lower urinary tract infection in pregnancy. A comparative double-blind randomised study of single dose fosfomycin trometamol with trimethoprim in the treatment of urinary tract infections in general practice.
Urinary tract infections in pregnancy: Monuril single-dose treatment versus traditional therapy. Single-dose fosfomycin trometamol versus multiple-dose cotrimoxazole in the treatment of lower urinary tract infections in general practice. Single-dose fosfomycin trometamol (Monuril) versus multiple-dose norfloxacin: results of a multicenter study in females with uncomplicated lower urinary tract infections. Fosfomycin trometamol versus norfloxacin in the treatment of uncomplicated lower urinary tract infections of the elderly. A general practitioner multicenter study: fosfomycin trometamol single dose versus pipemidic acid multiple dose. Single dose treatment of lower urinary tract infection in women: results of a trial with fosfomycin trometamol versus pefloxacin [in French]. Single dose fosfomycin trometamol versus multiple dose norfloxacin over three days for uncomplicated UTI in general practice. Fosfomycin trometamol in a single dose versus seven days nitrofurantoin in the treatment of acute uncomplicated urinary tract infections in women. A comparison between single-dose fosfomycin trometamol (Monuril®) and a 5-day course of trimethoprim in the treatment of uncomplicated lower urinary tract infection in women. Comparison of single-dose fosfomycin and a 7-day course of nitrofurantoin in female patients with uncomplicated urinary tract infection. Fosfomycin trometamol single-dose in the treatment of uncomplicated urinary tract infections in cardiac pregnant or non pregnant women: a controlled study [in Portuguese].
Single-dose fosfomycin trometamol versus 5-day cephalexin regimen for treatment of uncomplicated lower urinary tract infections in women.
Fosfomycin trometamol in a single dose versus norfloxacin for seven days in the treatment of uncomplicated urinary infections in general practice.
Single dose and conventional treatment for acute bacterial and non-bacterial dysuria and frequency in general practice. Fosfomycin trometamol versus amoxycillin: single-dose multicenter study of urinary tract infections. Fosfomycin versus other antibiotics for the treatment of cystitis: a meta-analysis of randomized controlled trials. AFSSAPS practice recommendations for diagnosis and antibiotic therapy of adult community urinary tract infections [in French]. Antibiotic prescription by general practitioners for urinary tract infections in outpatients.
Impact of a region wide antimicrobial stewardship guideline on urinary tract infection prescription patterns.
Randomized comparative study for the assessment of a new therapeutic schedule of fosfomycin trometamol in postmenopausal women with uncomplicated lower urinary tract infection [in Spanish]. Carbapenem versus fosfomycin tromethanol in the treatment of extended-spectrum beta-lactamase-producing Escherichia coli-related complicated lower urinary tract infection.
Fosfomycin in the treatment of extended spectrum beta-lactamase-producing Escherichia coli-related lower urinary tract infections.
Prevention of recurrent lower urinary tract infections by long-term administration of fosfomycin trometamol: double blind, randomized, parallel group, placebo controlled study. The efficacy of chronic therapy of recurrent lower urinary tract infections with fosfomycin and nitrofurantoin in type 2 diabetic patients. The effectiveness of single-dose fosfomycin as antimicrobial prophylaxis for patients undergoing transrectal ultrasound-guided biopsy of the prostate.
Prophylactic chemotherapy with fosfomycin trometamol versus placebo during transurethral prostatic resection. Prophylactic chemotherapy with fosfomycin trometamol salt during transurethral prostatic surgery: a controlled multicenter clinical trial.
Prophylactic chemotherapy with fosfomycin trometamol during transurethral surgery and urological manoeuvres: results of a multicentre study. Evaluation of fosfomycin trometamol in the prevention of urinary tract infection after ESWL and ureteropyeloscopy. Chemoprevention using fosfomycin trometamol in transurethral resection of the prostate: multicenter controlled clinical study [in Italian].
Effect and pharmacokinetics of netilmicin given as bolus intramuscular administration: an open comparative trial versus amikacin and fosfomycin in elderly patients affected by urinary tract infections.
Trometamol salt of fosfomycin (Monuril): preliminary pharmacokinetic and clinical experience in the treatment of urinary tract infections in children.
Trometamol salt of fosfomycin versus netilmicin: randomized multicenter study in children’s lower urinary tract infections. Treatment of lower urinary tract infections in children: single dose fosfomycin trometamol versus pipemidic acid.

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