Fosfomycin

Fosfomycin Brand Name– Monurol

What is Fosfomycin

Fosfomycin is an oral antibiotic used for the treatment of uncomplicated urinary tract infections (UTIs) caused by either E. coli or Enterococcus faecalis.

Fosfomycin is structurally similar to phosphoenolpyruvate, one of the precursors involved in the synthesis of peptidoglycan. Unlike beta-lactams, fosfomycin disrupts the building of bacterial cell walls by blocking formation of cell wall precursors rather than blocking peptide cross-linking.

The combination of fosfomycin and a beta-lactam may be synergistic.

Fosfomycin was originally discovered in 1969 and may be listed as “phosfomycin” in some US references.

It has been available in Europe since 1988. Since it sustains effective urinary concentrations for over 3 days, fosfomycin is approved for single-dose treatment of uncomplicated urinary tract infection, however, efficacy as a single dose agent appears to be less than that for fluoroquinolones or co-trimoxazole. 

In vitro data suggest that fosfomycin may also be effective for other UTIs caused by gram-negative rods, however, no clinical data are available at this time to support using fosfomycin in UTIs involving these pathogens.

Fosfomycin was FDA approved December 18, 1996 and is currently available in 19 foreign countries.

Indications

  1. Citrobacter diversus
  2. Citrobacter freundii
  3. cystitis
  4. Enterococcus faecalis
  5. Enterococcus faecium
  6. Escherichia coli
  7. Klebsiella oxytoca
  8. Klebsiella pneumoniae
  9. Proteus mirabilis
  10. Proteus vulgaris
  11. Serratia marcescens
  12. urinary tract infection (UTI)

Side Effects

  1. abdominal pain
  2. anaphylactoid reactions
  3. angioedema
  4. anorexia
  5. aplastic anemia
  6. asthenia
  7. back pain
  8. constipation
  9. diarrhea
  10. dizziness
  11. drowsiness
  12. dysmenorrhea
  13. dyspepsia
  14. dysuria
  15. elevated hepatic enzymes
  16. fever
  17. flatulence
  18. headache
  19. hearing loss
  20. hematuria
  21. hepatic necrosis
  22. infection
  23. influenza
  24. insomnia
  25. jaundice
  26. lymphadenopathy
  27. migraine
  28. myalgia
  29. nausea
  30. optic neuritis
  31. paresthesias
  32. pharyngitis
  33. pruritus
  34. pseudomembranous colitis
  35. rash
  36. rhinitis
  37. superinfection
  38. toxic megacolon
  39. vaginitis
  40. vomiting
  41. xerostomia

Monitoring Parameters

  • laboratory monitoring not necessary

Contraindications

  • breast-feeding
  • children
  • colitis
  • diarrhea
  • geriatric
  • GI disease
  • infants
  • inflammatory bowel disease
  • neonates
  • pregnancy
  • pseudomembranous colitis
  • ulcerative colitis

Interactions

  • Bethanechol
  • Cisapride
  • Metoclopramide
  • Prucalopride
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