In Reply Dr Barros refers to unpublished data on clinical cure rates for fosfomycin mentioned in the article.1 These data are from a randomized clinical trial conducted by the makers of fosfomycin in the 1990s. The data were evaluated extensively by the US Food and Drug Administration, which had to send a warning letter to the company2 because it was selectively advertising fosfomycin’s “successful clinical cure rate in over 700 women” of 70% without disclosing that the women were enrolled in a comparative trial in which the success rates for ciprofloxacin and trimethoprim-sulfamethoxazole were 96% and 94%, respectively.3 The trial sponsor’s decision never to publish these results is not surprising, but lack of publication does not mean that the data are not valid. The narrative reviews cited by Barros included only published articles, inflating fosfomycin’s presumed success rate.
Huttner A, Leibovici L, Harbarth S. Antibiotic Treatment for Uncomplicated Urinary Tract Infections—Reply. JAMA. 2018;320(12):1284–1285. doi:10.1001/jama.2018.10018
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