2. Fosfomycin (PO)
Bactericidal agent that is excreted into the urine and inhibits cell wall synthesis by interfering with peptidoglycan synthesis.
Spectrum: Broad spectrum vs Gram positive including MRSA, VRE; Gram negative including Pseudomonas and some ESBL’s .
Used for: Uncomplicated urinary tract infections in women, especially in those with history of resistant bugs. Given as a one-time mega-dose of 3 g (excreted into urine and achieves high levels there for several days. Sometimes used for complicated UTI’s in males with resistant pathogens (3 g PO q3 days x several doses), although this is an off-label use.
Acute bacterial sinusitis may be the complication of an initial viral illness. The primary bacterial isolates are S. aureus, S. pneumoniae, Haemophilus influenzae , and Moraxella catarrhalis . 9 The . Food and Drug Administration (FDA) has labeled gatifloxacin, moxifloxacin, sparfloxacin, and levofloxacin for use in the treatment of acute bacterial sinusitis. Clinical trials comparing fluoroquinolones with amoxicillin-clavulanate potassium (Augmentin), cefuroxime axetil (Ceftin), and clarithromycin (Biaxin) have demonstrated the efficacy of the quinolone antibiotics. 9 However, we believe that quinolones should not be used as first-line agents in the treatment of acute bacterial sinusitis because of the potential for development of bacterial resistance.
The 15 gram vial may be reconstituted with either 92 mL Sterile Water for Injection or % Sodium Chloride Injection. The diluent should be added in two separate aliquots in a suitable work area, such as a laminar flow hood. Add 50 mL of solution, shake to dissolve. Then add an additional 42 mL and shake. The solution should be allowed to stand after dissolution to allow any foaming to dissipate in order to permit visual inspection for complete solubilization. The resultant solution will have a final concentration of approximately 100 mg/mL ampicillin and 50 mg/mL sulbactam. The closure may be penetrated only one time after reconstitution, if needed, using a suitable sterile transfer device or dispensing set that allows for measured dispensing of the contents.