Fosfomycin Dosing Considerations in Acute Kidney Injury

Introduction to Fosfomycin Dosing

• The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend that drug dosing should take GFR into account for medication management in kidney disease, including fosfomycin dosing in patients with acute kidney injury (AKI) 1
• Temporary discontinuation or dose adjustment of renally excreted drugs, such as fosfomycin, is recommended in patients with GFR < 60 ml/min/1.73 m² who have serious intercurrent illness that increases AKI risk, as suggested by the KDIGO guidelines 1
• Consider methods based on cystatin C or direct measurement of GFR when precision is required for dosing drugs with narrow therapeutic ranges, such as fosfomycin, in AKI patients 1

Clinical Considerations for Fosfomycin Dosing

• Assess the severity and cause of AKI before determining the appropriate fosfomycin dosing strategy, considering the recommendations from the American Journal of Kidney Diseases 1, 2
• Patients with cirrhosis and AKI may require special attention due to their altered pharmacokinetics and increased risk of hepatorenal syndrome, as noted in Clinical Gastroenterology and Hepatology 3, 4
• Avoid potentially nephrotoxic agents when possible to prevent worsening of AKI, as advised in Clinical Gastroenterology and Hepatology 3