The renoprotective effect of concomitant fosfomycin in the treatment of pulmonary exacerbations in cystic fibrosis.



Al-Aloul, Mohamed, Nazareth, Dilip ORCID: 0000-0002-6114-0467 and Walshaw, Martin
(2019) The renoprotective effect of concomitant fosfomycin in the treatment of pulmonary exacerbations in cystic fibrosis. Clinical kidney journal, 12 (5). 652 - 658.

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Abstract

Background:Fosfomycin, effective in Cystic Fibrosis (CF), competes with aminoglycosides at renal binding sites and may therefore afford a renoprotective effect when used in combination therapy. We explored this by using markers of acute renal tubular damage [N-acetyl-β-d-glucose-aminidase (NAG), alanine amino-peptidase (AAP) and β2-microglobulin]. Methods:Using a prospective randomized crossover trial design, at an acute pulmonary exacerbation, 18 adult CF patients received either 14 days of intravenous (IV) tobramycin or IV tobramycin and IV fosfomycin, both in combination with a second IV antibiotic (colomycin). Results:Urinary NAG (P = 0.003) and AAP (P = 0.03) following treatment with concomitant fosfomycin were lower than those after treatment with tobramycin and colomycin alone. Fosfomycin attenuated the total 24-h urinary protein leak (P = 0.0001). The 14-day improvements in all surrogate markers of exacerbation resolution (FEV1% predicted, FVC, white cell count and C-reactive protein) were similar for both treatment regimens. Conclusion:The addition of fosfomycin reduces acute renal injury caused by IV aminoglycoside therapy in CF pulmonary exacerbations.

Item Type: Article
Depositing User: Symplectic Admin
Date Deposited: 21 Oct 2019 08:46
Last Modified: 05 Oct 2022 22:31
DOI: 10.1093/ckj/sfz005
Open Access URL: https://doi.org/10.1093/ckj/sfz005
URI: https://livrepository.liverpool.ac.uk/id/eprint/3058918