Summary
Bacteriuria in pregnancy occurs in about one in 20 pregnant women and is usually initially asymptomatic. It is an important marker for acute symptomatic infection (often pyelonephritis) later in pregnancy, which occurs in about one in four bacteriurics. Several considerations surround the antibiotic treatment of the asymptomatic infection; these include a low frequency ofin vitro resistance to the agent used, lack of toxicity to the foetus, a low incidence of gastrointestinal side effects, good compliance and proven efficacy. Fosfomycin trometamol seems to fit these requirements. In three controlled studies (two multicentric) 250 patients were treated with fosfomycin trometamol in a 3 g (as fosfomycin) single dose; 197 patients were given one of three other agents. Cure rates for fosfomycin trometamol were 77–94% (68–94% for other agents), which was satisfactory in an infection which is sometimes difficult to eradicate. Further studies are needed in this important but accessible group of patients. Opportunities should be taken to study more foetal outcomes and provide more data on gastro-intestinal tolerability.
Zusammenfassung
Eine von 20 Frauen entwickelt in der Schwangerschaft eine Bakteriurie, die zunächst asymptomatisch bleibt. Die Bakteriurie ist ein wichtiger prognostischer Marker für eine akute symptomatische Infektion, die häufig als Pyelonephritis im weiteren Schwangerschaftsverlauf (bei einer von vier Frauen mit Bakteriurie) auftritt. Bei der antimikrobiellen Therapie der asymptomatischen Infektion müssen mehrere Gesichtspunkte berücksichtigt werden: die verwendete Substanz sollte eine geringeIn vitro-Resistenz aufweisen, für den Foeten nicht toxisch sein, geringe gastrointestinale Nebenwirkungen haben, gute Compliance sichern und erwiesene Effizienz besitzen. Diese Voraussetzungen scheinen für Fosfomycin Trometamol erfüllt zu sein. In drei kontrollierten (zwei multizentrischen) Studien wurden 250 Patientinnen mit Fosfomycin Trometamol mit einer Einmaldosis von 3 g (als Fosfomycin) behandelt. Bei 197 Patienten wurden drei verschiedene Vergleichssubstanzen eingesetzt. Die Heilungsraten für die mit Fosfomycin Trometamol behandelten Frauen betrugen 77–94% (für die Vergleichssubstanzen 68–94%). Diese Ergebnisse können für eine manchmal schwer eliminierbare Infektion als befriedigend angesehen werden. Weitere Studien in dieser wichtigen Patienten-Gruppe sind erforderlich. Auswirkungen beim Foeten und gastrointestinale Verträglichkeit sollten mehr Beachtung finden.
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Reeves, D.S. Treatment of bacteriuria in pregnancy with single dose fosfomycin trometamol: A review. Infection 20 (Suppl 4), S313–S316 (1992). https://doi.org/10.1007/BF01710022
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DOI: https://doi.org/10.1007/BF01710022