Sixty-two studies were included. These included four randomised controlled trials (RCTs, n=1,212 patients), 32 cohort studies (n=1,589 patients), nine case series (n=58 patients) and 17 case reports (n=17 patients).
Combined cohort and case series: For cohort studies and case series combined, the cure rate in patients who received fosfomycin-containing regimens was 81.1% (1,302 of 1,604 patients cured), with improvement in 2.9% (47 of 1,604 patients improved).
Cohort studies (31 studies): The overall cure rate was 81.2% (1,242 of 1,592 patients cured) with improvement in 2.9% (46 of 1,529 patients improved). Tolerance was considered good (based on 664 patients exposed to fosfomycin). The following adverse effects were reported: mild gastrointestinal symptoms 5.4% (36 patients); skin manifestations in 4% (27 patients); injection site pain or phlebitis in 3.0% (20 patients); and moderate increases in platelet count (2.1%, o14 patients), eosinophil count (1.2%, eight patients) and transaminase levels (0.1%, one patient). Resistance to fosfomycin was found in 10.8% (39 of 360 patients developed resistance).
Case series (nine studies): The overall cure rate was 77.6% (45 of 58 patients cured). No adverse effects were reported.
Results from case reports and results from five studies of fosfomycin prophylaxis were also reported.