Overview 

Fosfomycin, retailed under the brand name  Monurol  among others, is an antibiotic mainly used to deal with lower UTIs. It is not suggested for kidney infections. Sometimes it is used for prostate infections. It is mainly taken by mouth.

Q.1. What kind of antibiotic is fosfomycin?

1.  Broad-spectrum bactericidal antibiotic 
2. It interferes with cell wall synthesis in both Gram-negative and Gram-positive bacteria.

Uses of fosfomycin 

• complicated urinary tract infections 

− infective endocarditis

− bone and joint infections

− hospital-acquired pneumonia, including ventilator-associated pneumonia

− complicated skin and soft tissue infection

− complicated intra-abdominal infections 

• Bacterial meningitis 

Dose in general population 

• Take this medicine only as supervised by your doctor. 
• Don’t  take more of it, do not take it more frequently, and do not take it for an extended time than your doctor instructed. 
• Doing so may increase the chance for side effects.

Only one dose of this medicine is required to treat your UTI. The medicine will proceed to fight the infection.

The medicine is an orange-flavored powder that’s  why you must put  water in before using. Never gulp the medicine in its dry form.

To use:

• Unlock the packet and put  all of the powder into 3 or 4 ounces (1/2 cup) of water. Do not use warm  water.
• Mix until the powder is dissolved, and drink the mixture straight away.
• Drink more fluids so you will pass more urine while you are using this medicine. 

This will keep your bladder functioning well and help prevent bladder issues.

Dosage 

• The dose of this medicine will vary from patient to patient.  
• Listen to your doctor’s orders or the advice on the label. 
• The following guidance  contains only the average doses of this medicine. 

If your dose is different, do not alter it unless your doctor tells you to do so.

• The quantity of medicine that you take relies on the strength of the medicine.

Also, the number of doses you consume  each day, the time permitted between doses, and the duration of time you take the medicine depend on the medical issue for which you are using the medicine.

For oral dosage form (powder for solution):-

In case of bladder infection:-

• Youths —3 grams (one packet) mixed  in water one time.
• Teenagers 13 to 17 years of age—Dose must be specified by your doctor.
• Children 12 years of age or  below—Use and dose must be specified by your doctor.

When dealing with bacterial infections it is crucial to complete the full course of treatment. 

Even after the fever has passed and the  symptoms have diminished, treatment should be continued for a few days more .

In patients with renal impairment

• This medicine should not be consumed by  patients with severe renal impairment (creatinine clearance < 10 ml/min.).

Patients undergoing chronic intermittent dialysis (every 48 hours) should have 2 g of fosfomycin at the end of each dialysis session. 

Fosfomycin  with food

Food may lag the absorption of fosfomycin. Hence, this medicinal product should be taken before eating or on an empty stomach ( 2-3hours before or 2-3 hours after a meal ).

Storage

• Store the medicine in a sealed container at room temperature, far  from heat, moisture, and direct light. Protect from freezing.
• Be aware to keep  out of the reach of the  children.
• Do not keep expired  medicine or medicine no longer required.

Talk to your healthcare professional about how you should dispose of any medicine you do not use.

Side effects :- 

More common

• Itching of the vagina or genital region
• Pain and discomfort  during sexual intercourse
• thick, white vaginal release with no odor or with a mild odor

Less common

• Acid or sour stomach
• Back Pain
• body aches 
• congestion
• soreness of the throat
• heartburn
• heavy bleeding
• absence or loss of strength
• painful menstruation

Some side effects may occur that often  do not require medical attention.

•  These side effects may fade  away during treatment as your body adapts to the medicine. 
• Also, your health care professional may be able to tell you about strategies to prevent or decrease some of these side effects. 

Drug Interactions 

This information should not be inferred without the assistance of a healthcare provider

• If you think you are experiencing an interaction, call your  healthcare provider instantly. The absence of an interaction does not certainly imply no interactions exist.

Major Drug Interaction 

Metoclopramide

When co-administered with MONUROL, metoclopramide, a drug which raises gastrointestinal motility, lowers the serum concentration and urinary excretion of fosfomycin. Other drugs that raise gastrointestinal motility may generate similar effects.

Cimetidine

Cimetidine does not impact  the pharmacokinetics of fosfomycin when co-administered with Monurol

Brands available in India

In India fosfomycin is available in the following brand name:-

1. Novefos 
2. Fosidal Powder 
3. Fosirol Sachet
4. Monurol  Sachet

Contraindications

Fosfomycin is very safe for the medication of uncomplicated urinary tract infections, but it’s not good for everyone. Be confident to tell your doctor if you:

1. Are pregnant or breastfeeding.

In specific, metoclopramide (Reglan) and cisapride (Propulsid) may make fosfomycin less useful.

2. Also tell your healthcare provider about any vitamins or supplements you consume.

1. If you are  allergic to an antibiotic or have a history of medication allergies or hypersensitivity.
2. If you have  glucose-6-phosphate dehydrogenase (G6PD) deficiency. People with this genetic condition are more vulnerable to anemia, and occasionally their bodies can’t tolerate antibiotics.

Frequently asked questions ( FAQs)

1. Is fosfomycin good for UTIs?

• Fosfomycin is a safe and useful antibacterial drug for urinary tract infections, but its use should be restricted to delay the growth of resistance.
•  It will prove to be an effective treatment option for community-based treatment of patients with resistant organisms

1. Can I pee after taking fosfomycin?

Drink more fluids so you will pass more urine while you are consuming this medicine. This will keep your bladder functioning well and help prevent bladder issues.

1. What is the best time to take fosfomycin?

Fosfomycin is for oral administration and should be taken on an empty stomach, either 1 hour before or at least 2 hours after meals and mostly  before bedtime after clearing the bladder. The contents of a sachet should be mixed  in a glass of water and taken soon after its preparation.

1. How quickly does fosfomycin work?

How long does fosfomycin (Monurol) take to act? You should realize an improvement in your symptoms within a period of  2 to 3 days of taking fosfomycin (Monurol). If your symptoms do not get better, contact your healthcare provider.

1. Can fosfomycin treat kidney infection?

Fosfomycin should not be utilized to treat infections outside the bladder (e.g., kidney infections such as pyelonephritis or perinephric abscesses). This antibiotic treats just bacterial infections. It will not function for viral infections (e.g., common cold, flu).

Warnings

1. Fosfomycin shouldn’t result in any major reactions in your body, so if you have severe nausea, vomiting, fever, or muscle pain, talk to your doctor ASAP. 
2. Your UTI should go away within a few days, but if your symptoms persist, let your doctor know. Occasionally the body doesn’t react to an antibiotic.
3. In this case, the “bad” bacteria in your body may have formulated something called fosfomycin resistance, meaning they’ve figured out the path  to evade this antibiotic and survive. 
4.  Antibiotic resistance is unfortunately very common—at least 2.8 million Americans get an antibiotic-resistant infection every year.

It’s a problem that microbiologists continue to study. All you require to know is your doctor will likely collect a urine culture to observe the type(s) of bacteria in your urinary tract and then jot down another prescription for you.