Discussion
fever, cUTI, infection, bacteraemia, pyelonephritis, febrile UTI
COMPLICATED URINARY TRACT INFECTION, PYELONEPHRITIS, INFECTION, UTI, URINARY TRACT INFECTION
In the FOREST trial, step-down to any oral therapy was used more frequently in patients assigned to IV fosfomycin than in those assigned to IV ceftriaxone or meropenem, which could be explained by differences in reaching the criteria for oral step-down (as seen by differences in reaching early clinical response) and because susceptibility to other oral drugs was less frequent in the latter (particularly for ceftriaxone-resistant isolates), confirming that fosfomycin trometamol is a potential alternative for oral step-down drug in patients with MDR Fosfomycin trometamol has been traditionally used for uncomplicated cystitisRegarding clinical studies, we found only two studies comparing fosfomycin trometamol with other oral drugs as step-down regimens in patients with cUTI and fever, pyelonephritis and/or bacteraemia; their data in comparison with this study are shown in Table Features of studies comparing fosfomycin trometamol as oral step-down with other drugs in patients with complicated urinary tract infections including fever, pyelonephritis and/or bacteraemiaAMC, amoxicillin/clavulanic acid; CIP, ciprofloxacin; COMP, comparators; cUTI, complicated urinary tract infection; CXM, cefuroxime axetil; ETP, ertapenem; FOF, fosfomycin trometamol; SXT, trimethoprim/sulfamethoxazole; UTI, urinary tract infection.Clinical cure defined as resolution of signs and symptoms of infection without relapse at Day 30.Clinical cure defined as being alive with reduction of all initial local and systemic febrile UTI-related symptoms, without the requirement of additional antibiotic therapy for UTI, at Days 6–10 post-end of treatment.Clinical cure defined as resolution of all new signs and symptoms of infection, 5–7 days after end of treatment.The second study was a double-blind randomized trial in women with febrile UTI due to Overall, comparison of our results with these studies is complex because of the differences in inclusion criteria, features of patients and microorganisms (Table Some recent studies have shown that uncomplicated bacteraemia due to Enterobacterales may be treated for only 7 days, mostly with β-lactams or fluoroquinolones.Limitations of this study include lack of randomization for oral step-down; therefore, we used multivariate analysis to adjust for confounders. Also, the sample size was limited. The comparators included different drugs, although all had been shown to be similarly effective as step-down options.In conclusion, fosfomycin trometamol might be useful as step-down therapy in patients with BUTI due to susceptible 