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Drug Res (Stuttg) 2024; 74(01): 24-31
DOI: 10.1055/a-2195-3032
Review

Parenteral Fosfomycin in Gastrointestinal Surgery: A Systematic Review

Siv Fonnes‡
1   Centre for Perioperative Optimisation, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
,
Masja Klindt Fonnes‡
1   Centre for Perioperative Optimisation, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
,
Barbara Juliane Holzknecht
2   Department of Clinical Microbiology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
3   Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
,
Jacob Rosenberg
1   Centre for Perioperative Optimisation, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
3   Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
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Abstract

Background To investigate if perioperative parenteral administration of fosfomycin given before or during gastrointestinal surgery could protect against postoperative infectious complications and characterise the administration of fosfomycin and its harms.

Methods This systematic review included original studies on gastrointestinal surgery where parental administration of fosfomycin was given before or during surgery to≥5 patients. We searched three databases on March 24 2023 and registered the protocol before data extraction (CRD42020201268). Risk of bias was assessed with Cochrane Handbook risk of bias assessment tool or the Newcastle-Ottawa Scale. A narrative description was undertaken. For infectious complications, results from emergency and elective surgery were presented separately.

Results We included 15 unique studies, reporting on 1,029 patients that received fosfomycin before or during gastrointestinal surgery. Almost half of the studies were conducted in the 1980s to early 1990s, and typically a dose of 4 g fosfomycin was given before surgery co-administered with metronidazole and often repeated postoperatively. The risk of bias across studies was moderate to high. The rates of infectious complications were low after fosfomycin; the surgical site infection rate was 0–1% in emergency surgery and 0–10% in elective surgery. If reported, harms were few and mild and typically related to the gastrointestinal system.

Conclusion There were few postoperative infectious complications after perioperative parenteral administration of one or more doses of 4 g fosfomycin supplemented with metronidazole in various gastrointestinal procedures. Fosfomycin was associated with few and mild harms.

Keywords

fosfomycin - gastrointestinal surgical procedure - systematic review - postoperative complications - adverse effects

Supplementary Material



Publication History

Received: 30 June 2023

Accepted: 16 October 2023

Article published online:
28 November 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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