Nitrofurantoin and Fosfomycin

With the rise in resistance among common urinary tract pathogens (primarily Escherichia coli), first among TMP/SMX and more recently among the fluoroquinolones, clinicians are left searching for an alternative to treat their patients with uncomplicated cystitis.  Nitrofurantoin and fosfomycin, although structurally dissimilar with different mechanisms of action, are two agents that have similar clinical use. They have retained excellent activity against E. coli (greater 90%) in most studies and also have adequate coverage of other common community-acquired urinary tract pathogens.