Fosfomycin sodium, as a broad-spectrum antibiotic, acts by inhibiting the early synthesis of the bacterial cell wall. Unlike other mainstream antimicrobial drugs such as β-lactams, aminoglycosides, and quinolones, this unique mechanism gives it significant advantages in terms of its antibacterial spectrum, resistance, and safety. The following are the key comparative advantages of fosfomycin sodium compared to similar or commonly used clinical antimicrobial agents: | Comparison Dimension | Fosfomycin Sodium | β-Lactams (Penicillin/Cephalosporins) | Aminoglycosides (Gentamicin/Amikacin) | Quinolones (Levofloxacin/Ciprofloxacin) | Vancomycin | Metronidazole | |------------------|------------------|------------------|------------------|------------------|------------------| | Target of Action | First step in bacterial cell wall synthesis (UDP-N-acetylglucosamine conversion) | Final step in bacterial cell wall synthesis (teichoic acid cross-linking) | 30S subunit of bacterial ribosomes (protein synthesis) | Bacterial DNA gyrase/topoisomerase IV | Bacterial DNA synthesis (specific to anaerobes) | | Antibacterial Spectrum | Broad-spectrum: Gram-positive and Gram-negative bacteria, with mild activity against some anaerobes | Broad-spectrum: Gram-positive and Gram-negative bacteria (including third-generation cephalosporins) | Broad-spectrum: Gram-positive and Gram-negative bacteria (including Pseudomonas aeruginosa) | Broad-spectrum: Gram-positive and Gram-negative bacteria; poor effect on anaerobes | Narrow-spectrum: Only Gram-positive bacteria (including MRSA) | | Resistance | Very low natural resistance; target is not prone to mutation; no inactivating enzymes | Prone to β-lactamases, leading to high resistance rates | Prone to aminoglycoside inactivating enzymes, leading to high resistance rates | Target mutation and upregulation of efflux pumps, increasing resistance rates over time | Occasionally resistant to vancomycin (VRE/VISA); low resistance rates in anaerobes | | Cross-allergy | None | Some cross-allergies between penicillins and cephalosporins | None | None | None | | Suitable Populations | Children and pregnant women can use with caution; dosage adjustment for renal impairment | Contraindicated in those allergic; use as needed for pregnant women/children (penicillin with caution) | Children and the elderly should use with caution; strict dosage adjustment for renal impairment | Contraindicated in those under 18 years old; avoid use in pregnant women; use with caution in the elderly | | Side Effects | Mild gastrointestinal reactions, local pain at intramuscular injection; allergic reactions (rashes/anaphylactic shock), gastrointestinal reactions, secondary infections | Ototoxicity, nephrotoxicity; neuromuscular blockade, prolonged QT interval, cartilage damage, dizziness/epilepsy | Red man syndrome, nephrotoxicity, ototoxicity, gastrointestinal reactions, metallic taste in mouth; occasional neurotoxicity | Gastrointestinal reactions | | Penetration | Strong penetration: blood-brain barrier, placenta, prostate capsule; high concentrations in urine/ bile | Moderate penetration; low concentration in brain tissue | Weak penetration; mainly distributed within blood vessels | | Drug Interaction | Synergistic effect when combined with β-lactams/aminoglycosides/quinolones, reducing resistance | No synergistic effect when combined with similar drugs; may increase adverse reactions | Contraindicated with certain drugs; synergistic effect when combined with fosfomycin sodium | | Clinical Advantages | Low resistance, no cross-allergies, high safety, broad spectrum, strong penetration | Multiple formulations available; well-established clinical use | Strong antibacterial activity; concentration-dependent killing effect | | Administration Forms | Oral and injectable forms; rapid onset of action | Effective against Gram-positive bacteria (including MRSA); preferred for anaerobic infections | High cost | | Clinical Limitations | Limited effectiveness against certain infections; high risk of allergic reactions | Significant ototoxicity and nephrotoxicity; restricted use due to side effects | Narrow spectrum; poor penetration; requires combination therapy | **Summary:** Fosfomycin sodium, with its unique mechanism of action, offers several clinical advantages, including low resistance, no cross-allergies, high safety, and broad-spectrum coverage. It is a preferred broad-spectrum antibiotic for patients allergic to penicillins or cephalosporins, as well as for children, the elderly, and those with renal impairment. It is effective against a variety of infections and has a wide range of dosage forms. Its combination with other antimicrobial agents can enhance efficacy. The low cost makes it an attractive option for clinical use. Fosfomycin sodium’s unique properties make it an ideal choice for treating urinary tract infections, mixed infections, and severe infections, especially in patients with renal impairment.