GRAM-NEGATIVE INFECTIONS: Edited by Matteo BassettiThe role of fosfomycin for multidrug-resistant gram-negative infectionsBassetti, Matteoa,b; Graziano, Elenaa; Berruti, Marcob; Giacobbe, Daniele RobertobAuthor Information aDepartment of Medicine, Infectious Diseases Clinic, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine bDepartment of Health Sciences, University of Genoa, Genoa, Italy Correspondence to Matteo Bassetti, Clinica Malattie Infettive, Azienda Sanitaria Universitaria Integrata di Udine, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Piazzale Misericordia 15, 33100 Udine, Italy. Tel: +39 0432 559353; fax: +39 0432 559360; e-mail: [email protected] Current Opinion in Infectious Diseases: December 2019 - Volume 32 - Issue 6 - p 617-625 doi: 10.1097/QCO.0000000000000597 Buy Metrics Abstract Purpose of review In the last decade, an increasing interest in using fosfomycin for the treatment of multidrug-resistant gram-negative (MDR-GNB) infections have been registered, especially when none or only a few other active alternatives remained available. Recent findings Fosfomycin may remain active against a considerable proportion of MDR-GNB. In observational studies, a possible curative effect of oral fosfomycin monotherapy has been described for uncomplicated urinary tract infections (UTI) and bacterial prostatitis caused by MDR-GNB, whereas intravenous fosfomycin has been mostly used in combination with other agents for various type of severe MDR-GNB infections. The ZEUS randomized controlled trial (RCT) has started to provide high-level evidence about the possible use of fosfomycin for complicated UTI caused by extended-spectrum β-lactamase-producing GNB, but no results of large RCT are currently available to firmly guide the use of fosfomycin for carbapenem-resistant GNB. Summary Fosfomycin is an important therapeutic option for MDR-GNB infections. Further pharmacokinetic/pharmacodynamic and clinical research is needed to optimize its use. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.