Fosfomycin

Fosfomycin is a broad-spectrum antibiotic that blocks an early step in bacterial cell-wall synthesis. It is used especially for uncomplicated urinary tract infections.

MurA: MurA is a bacterial enzyme that catalyzes the first committed step in peptidoglycan precursor synthesis. Fosfomycin irreversibly inhibits MurA, stopping production of a cell-wall building block.
Uncomplicated urinary tract infection: An uncomplicated urinary tract infection is a bladder infection in a patient without relevant structural or systemic complications. Oral fosfomycin trometamol is commonly used as a single-dose option for this infection.
Nitrofurantoin: Nitrofurantoin is an antibiotic used mainly for lower urinary tract infections. It is a common oral alternative for uncomplicated cystitis, with different activity and resistance patterns.
Bacterial cell wall synthesis: Bacterial cell wall synthesis is the sequence of reactions that builds and remodels peptidoglycan. Fosfomycin interrupts this pathway at an early cytoplasmic reaction.
Glycerol-3-phosphate transporter: GlpT is a membrane transporter that imports glycerol-3-phosphate and related molecules into bacterial cells. Many bacteria use GlpT to bring fosfomycin across the inner membrane.
Fosfomycin trometamol: Fosfomycin trometamol is an oral salt formulation that delivers fosfomycin for treatment of urinary infections. This formulation concentrates active drug in urine and is used for selected bladder infections.
Trimethoprim: Trimethoprim inhibits bacterial dihydrofolate reductase and is used alone or with sulfamethoxazole against infections. It is another possible urinary antibiotic, but its usefulness depends on local susceptibility.
Peptidoglycan biosynthesis: Peptidoglycan biosynthesis is the enzymatic production and assembly of the mesh that supports bacterial cell walls. Fosfomycin blocks its first committed precursor-building step.
Glucose-6-phosphate transporter: UhpT is a bacterial membrane transporter that exchanges glucose-6-phosphate with inorganic phosphate. UhpT provides another route for fosfomycin entry in susceptible bacteria.
Intravenous fosfomycin: Intravenous fosfomycin is a systemic formulation used in some countries for serious bacterial infections. It extends fosfomycin use beyond oral treatment of uncomplicated bladder infections.

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