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Ibuprofen versus fosfomycin for uncomplicated urinary tract infection in women: randomised controlled trial

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h6544 (Published 23 December 2015) Cite this as: BMJ 2015;351:h6544

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Re: Ibuprofen versus fosfomycin for uncomplicated urinary tract infection in women: randomised controlled trial

We have read the research findings of Gagyor et al. with interest. However, we wish to point out that the choice of using fosfomycin in the treatment arm wouldn't be advisable as first line treatment for uncomplicated urinary tract infections. Other antimicrobials such as nitrofurantoin would be preferrable.The reason being that this antimicrobial is reserved for highly resistant organisms and in particular extended spectrum beta-lactamase (ESBL) producing Gram-negative bacteria. Furthermore, fosfomycin in its intravenous form is now licensed for the treatment of a range of highly resistant Gram-negative organisms; therefore the frequent use of oral fosfomycin to treat a very common infection i.e. UTI would invalidate its use because of the inevitable emergence of resistance.

It is always best practice to test the urine for culture and sensitivity to establish not only the nature of the infecting organism and its sensitivity pattern but also the prevalence of antimicrobial resistance in a particular demographic region.

Competing interests: No competing interests

10 January 2016
Walid Al-Wali
Consultant Medical Microbiologist and Director for Infection Prevention and Control.
Christopher Hughes, Clinical Scientist in Clinical microbiology
The Rotherham NHS Foundation Trust
Moorgate Road, Oakwood, Rotherham, S60 2UD, United Kingdom.