Fosfomycin

Phosphonic Acid Derivative·Infectious Diseases - Urinary Agents

Acute uncomplicated lower urinary tract infections in females

PBSANTIBIOTICMonurolGranules for oral solution (…S4+1

Max Dose

3 g STAT

Half-life

4 h

Freq

SINGLE DOSE

Pyelonephritis

CONTRAIND.

Rapid Summary

Overview

Unique bactericidal antibiotic that completely bypasses standard resistance mechanisms. Administered as a single, massive oral sachet. Exclusively treats uncomplicated cystitis.

Maximum Dose

Max 3 g (Given as a single, one-off STAT dose).

Clinical Focus

Do not use for pyelonephritis or systemic infections. It only concentrates in the bladder urine.

Bottom Line

Fosfomycin is a single-dose oral antibiotic for uncomplicated UTIs including ESBL-producing organisms, but is only effective for lower UTIs and resistance can develop rapidly with repeated use.

Formulation & Access

Brand Names

Monurol

Oral Routes

Granules for oral solution (3 g sachet). Orange/citrus flavored.

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Acute uncomplicated lower urinary tract infections in females.

Clinical Place

Highly effective 'last line' oral agent for highly resistant (ESBL/VRE) lower UTIs, preventing the need for IV admissions.

Quick reference

Class & Role

Phosphonic Acid Derivative — Unique bactericidal antibiotic that completely bypasses standard resistance mechanisms.

Route / Formulation

Granules for oral solution (3 g sachet). Orange/citrus flavored. (Monurol)

Usual Dose & Max

PO 3 g STAT as a single dose. Dissolve the sachet in a glass of cold water. Take on an empty stomach before bed after emptying the bladder. Max 3 g (Given as a single, one-off STAT dose).

Key Indication Doses

Uncomplicated Cystitis (Females): PO 3 g STAT as a single dose. Dissolve the sachet in a glass of cold water. Take on an empty stomach before bed after emptying the bladder. Renal Impairment: Avoid if eGFR < 30. It will not reach the bladder to kill the bacteria.

Best Uses

Fosfomycin is a single-dose oral antibiotic for uncomplicated UTIs including ESBL-producing organisms, but is only effective for lower UTIs and resistance can develop rapidly with repeated use.

Avoid / Cautions

eGFR < 30, severe systemic infection, pyelonephritis. Pregnancy Category B2. Safe and highly convenient for UTIs in pregnancy.

Key Risks

Gastrointestinal: Diarrhea, nausea, dyspepsia (very common, transient). Neurological: Dizziness, headache. Immunological: Rash.

Key Interactions

Metoclopramide accelerates gastric emptying and drastically reduces the absorption of fosfomycin. Separate or avoid.

Monitoring

Educate the patient to take it AT NIGHT, after urinating. This allows the drug to sit undisturbed in the bladder pool overnight, maximizing bacterial killing time.

Clinical Pearl

When a urine culture returns an ESBL E. coli that is resistant to Trimethoprim, Cephalexin, and Augmentin, Fosfomycin is often the only oral sensitivity left. It saves the patient from a 5-day IV Meropenem admission.

Access

MonurolGranules for oral solution (…

Brand: Monurol
Formulation: Granules for oral solution (3 g sachet)

Fosfomycin

Phosphonic Acid Derivative·Infectious Diseases - Urinary Agents

Acute uncomplicated lower urinary tract infections in females

PBSANTIBIOTICMonurolGranules for oral solution (…S4+1

Max Dose

3 g STAT

Half-life

4 h

Freq

SINGLE DOSE

Pyelonephritis

CONTRAIND.

Rapid Summary

Overview

Unique bactericidal antibiotic that completely bypasses standard resistance mechanisms. Administered as a single, massive oral sachet. Exclusively treats uncomplicated cystitis.

Maximum Dose

Max 3 g (Given as a single, one-off STAT dose).

Clinical Focus

Do not use for pyelonephritis or systemic infections. It only concentrates in the bladder urine.

Bottom Line

Fosfomycin is a single-dose oral antibiotic for uncomplicated UTIs including ESBL-producing organisms, but is only effective for lower UTIs and resistance can develop rapidly with repeated use.

Formulation & Access

Brand Names

Monurol

Oral Routes

Granules for oral solution (3 g sachet). Orange/citrus flavored.

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Acute uncomplicated lower urinary tract infections in females.

Clinical Place

Highly effective 'last line' oral agent for highly resistant (ESBL/VRE) lower UTIs, preventing the need for IV admissions.

Quick reference

Class & Role

Phosphonic Acid Derivative — Unique bactericidal antibiotic that completely bypasses standard resistance mechanisms.

Route / Formulation

Granules for oral solution (3 g sachet). Orange/citrus flavored. (Monurol)

Usual Dose & Max

PO 3 g STAT as a single dose. Dissolve the sachet in a glass of cold water. Take on an empty stomach before bed after emptying the bladder. Max 3 g (Given as a single, one-off STAT dose).

Key Indication Doses

Best Uses

Fosfomycin is a single-dose oral antibiotic for uncomplicated UTIs including ESBL-producing organisms, but is only effective for lower UTIs and resistance can develop rapidly with repeated use.

Avoid / Cautions

eGFR < 30, severe systemic infection, pyelonephritis. Pregnancy Category B2. Safe and highly convenient for UTIs in pregnancy.

Key Risks

Gastrointestinal: Diarrhea, nausea, dyspepsia (very common, transient). Neurological: Dizziness, headache. Immunological: Rash.

Key Interactions

Metoclopramide accelerates gastric emptying and drastically reduces the absorption of fosfomycin. Separate or avoid.

Monitoring

Educate the patient to take it AT NIGHT, after urinating. This allows the drug to sit undisturbed in the bladder pool overnight, maximizing bacterial killing time.

Clinical Pearl

Access

MonurolGranules for oral solution (…

Brand: Monurol
Formulation: Granules for oral solution (3 g sachet)