<unk>  is used to treat bladder infections, where it is usually given as a single dose by mouth. Oral<unk>  is not recommended for children under 12 years old. Additional uses have been proposed. The global problem of advancing antimicrobial resistance has led to a renewed interest in its use more recently.<unk>  can be used as an efficacious treatment for both UTIs and complicated UTIs including acute pyelonephritis. The standard regimen for complicated UTIs is an oral 3 g dose administered once every 48 or 72 hours for a total of 3 doses or a 6 g dose every 8 hours for 7–14 days when<unk>  is given in IV form. Intravenous<unk>  is being increasing used for treating infections caused by multidrug-resistant bacteria, mostly as partner drug in order to avoid the occurrence of resistances and to take advantage of its synergistic activity with several other antimicrobials. Daily adult dose usually ranges from 12 to 24 grams. Bacterial sensitivity The<unk>  molecule has an epoxide or oxirane ring, which is highly strained and thus very reactive.<unk>  has broad antibacterial activity against both Gram-positive and Gram-negative pathogens, with useful activity against E. faecalis, E. coli, and various Gram-negatives such as Citrobacter and Proteus. Given a greater activity in a low-pH milieu, and predominant excretion in active form into the urine,<unk>  has found use for the prophylaxis and treatment of UTIs caused by these uropathogens. Of note, activity against S. saprophyticus, Klebsiella, and Enterobacter is variable and should be confirmed by minimum inhibitory concentration testing. Activity against extended-spectrum β-lactamase-producing pathogens, notably ESBL-producing E. coli, is good to excellent, because the drug is not affected by cross-resistance issues. Existing clinical data support use in uncomplicated UTIs, caused by susceptible organisms. However, susceptibility break-points of 64 mg/l should not be applied for systemic infections. Resistance Development of bacterial resistance under therapy is a frequent occurrence and makes<unk>  unsuitable for sustained therapy of severe infections. Mutations that inactivate the nonessential glycerophosphate transporter render bacteria resistant to<unk> . Prescribing<unk>  together with at least another active drug reduces the risk of developing bacterial resistance.<unk>  acts synergistically with many other antibiotics, including cephalosporins, carbapenems, daptomycin and aminoglycosides. Enzymes conferring resistance to<unk>  have also been identified and are encoded both chromosomally and on plasmids. Three related<unk>  resistance enzymes (named<unk> A,<unk> B, and<unk> X) are members of the glyoxalase superfamily. These enzymes function by nucleophilic attack on carbon 1 of<unk> , which opens the epoxide ring and renders the drug ineffective. The enzymes differ by the identity of the nucleophile used in the reaction: glutathione for<unk> A, bacillithiol for<unk> B, and water for<unk> X. In general,<unk> A and<unk> X enzymes are produced by Gram-negative bacteria, whereas<unk> B is produced by Gram-positive bacteria.<unk> C uses ATP and adds a phosphate group to<unk> , thus altering its properties and making the drug ineffective.
Fosfomycin
Meropenem
Colistin
Ertapenem
Vancomycin
Resistin
Imipenem
Linezolid