TOPLINE:

Intravenous (IV) fosfomycin-based combination therapy was safe and well tolerated in high-risk paediatric patients (aged 0-18 years) with multidrug-resistant (MDR) infections, with minimal adverse events and no treatment discontinuation.

METHODOLOGY:

• Researchers in Italy conducted a single-centre retrospective study to evaluate the efficacy and safety of IV fosfomycin-based combination therapy in paediatric patients (aged 0-18 years) with complex infections.
• They included 50 paediatric patients with underlying comorbidities, immunosuppression, invasive devices, or prematurity (median age, 5.93 years; 54% boys) who received IV fosfomycin between 2019 and 2025.
• Fosfomycin was administered exclusively as combination therapy. Dosages ranged from 100 mg/kg/d in premature infants to 12-24 g/d in patients older than 12 years. It was used as a rescue therapy in cases of the failure of first-line treatments, confirmed or suspected MDR pathogens, and critical clinical situations requiring compassionate use.
• Microbiological data were obtained from blood cultures, site-specific cultures, and surveillance swabs.

TAKEAWAY:

• Microbiologically confirmed infection was reported in 90% of paediatric patients, with the majority of isolated pathogens demonstrating MDR including extended-spectrum beta-lactamase producers, carbapenem-resistant Enterobacterales, extensively drug-resistant organisms, and oxacillin-resistant gram-positive bacteria.
• Among confirmed cases, 53.4% were caused by gram-negative bacteria, and 46.6% were caused by gram-positive bacteria. Overall, 62.5% of gram-negative strains were resistant to first-line therapies, and 33.3% of all gram-positive strains were resistant to oxacillin.
• Recovery was achieved in 75% of patients with gram-negative infections and 85.7% of those with gram-positive infections; 20.8% died due to gram-negative infections, and 4.1% experienced treatment failure or relapse; notably, no mortality was reported in cases involving gram-positive bacteria, and 14.2% of those with gram-positive infections experienced relapse.
• Grade 1 hepatotoxicity developed in one patient, grade 2 developed in three patients, and grade 3 developed in one patient; none required discontinuation of the treatment.

IN PRACTICE:

"The use of IV fosfomycin in combination therapy appeared to be a reliable therapeutic option in managing difficult-to-treat infections in paediatric settings where standard antibiotics may be insufficient," the authors wrote.

SOURCE:

This study was led by Marco Denina and Laura Badiali, Infectious Diseases Unit, University of Turin, Regina Margherita Children's Hospital, Turin, Italy. It was published online on April 10, 2026, in the European Journal of Pediatrics.

LIMITATIONS:

The retrospective nature of the study may have introduced residual confounding. The study included a heterogeneous cohort of patients with varying underlying comorbidities, infections, and pathogens and lacked standardised microbiological monitoring during the treatment course. Additionally, the independent efficacy of fosfomycin could not be objectively evaluated due to the absence of a control group without fosfomycin.

DISCLOSURES:

This study did not receive any funding from any sources. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.