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Its unique mechanism of action, bactericidal activity, broad spectrum of activity, and relatively safe and tolerable adverse effect profile make it a great addition to the dwindling antibiotic armamentarium. Fosfomycin contains a three\u2010membered epoxide ring with a direct carbon to phosphorous bond that bypasses the intermediate oxygen bond commonly present in other organophosphorous compounds; this structure makes the agent unique from other antibiotics. Despite nearly 50 years of parenteral fosfomycin use in Europe, fosfomycin has retained stable activity against most pathogens. Furthermore, fosfomycin demonstrated in vitro synergy in combination with other cell wall\u2013active antibiotics (e.g., \u03b2\u2010lactams, daptomycin). These combinations may offer respite for severe infections due to\n                    <jats:styled-content style=\"fixed-case\">MDR<\/jats:styled-content>\n                    gram\u2010positive and gram\u2010negative bacteria. The intravenous (IV) formulation is currently under review in the United States, and apropos, this review collates more contemporary evidence (i.e., studies published between 2000 and early 2019) in anticipation of this development. The approval of IV fosfomycin provides another option for consideration in the management of\n                    <jats:styled-content style=\"fixed-case\">MDR<\/jats:styled-content>\n                    infections. Its unique structure will give rise to a promising epoxide epoch in the battle against\n                    <jats:styled-content style=\"fixed-case\">MDR<\/jats:styled-content>\n                    bacteria.\n                  <\/jats:p>","DOI":"10.1002\/phar.2326","type":"journal-article","created":{"date-parts":[[2019,9,5]],"date-time":"2019-09-05T10:29:15Z","timestamp":1567679355000},"page":"1077-1094","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Parenteral Fosfomycin for the Treatment of Multidrug Resistant Bacterial Infections: The Rise of the Epoxide"],"prefix":"10.1002","volume":"39","author":[{"given":"Trang D.","family":"Trinh","sequence":"first","affiliation":[{"name":"Medication Outcomes Center Department of Clinical Pharmacy School of Pharmacy University of California, San Francisco San Francisco California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1789-3517","authenticated-orcid":false,"given":"Jordan R.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Fred Wilson School of Pharmacy High Point University High Point North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2220-0081","authenticated-orcid":false,"given":"Michael J.","family":"Rybak","sequence":"additional","affiliation":[{"name":"Anti\u2010Infective Research Laboratory Department of Pharmacy Practice Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University Detroit Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,10,14]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01165-15"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw636"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.166.3901.122"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2016.02.001"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s15010-019-01323-4"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir838"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkx438"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz181"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1201\/9781498747967"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.1974.tb43277.x"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkp282"},{"key":"e_1_2_12_13_1","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1128\/jb.113.2.895-900.1973","article-title":"Isolation and characterization of mutations affecting the transport of hexose phosphates in Escherichia coli","volume":"2","author":"Kadner RJ","year":"1973","journal-title":"J Bacteriol"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1159\/000472869"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1574-6968.2010.02049.x"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.45.11.3182-3188.2001"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2018.08.010"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-005-1307-9"},{"key":"e_1_2_12_19_1","unstructured":"Clinical and Laboratory Standards Institute.M100\u2010ED29: 2019 Performance Standards for Antimicrobial Susceptibility Testing 29th ed. 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