From the Guidelines
Fosfomycin (Monurol) is recommended for the treatment of Urinary Tract Infections (UTI) as a single dose of 3g.
Dosage and Frequency
- The recommended dosage of Fosfomycin for the treatment of UTI is 3g as a single dose 1.
- This single-dose regimen is convenient and has minimal propensity for collateral damage, making it a useful choice for some patients 1.
Clinical Efficacy
- The clinical efficacy of Fosfomycin is comparable to other first-line agents, with an estimated clinical efficacy rate of 91% 1.
- However, the bacterial efficacy of Fosfomycin is lower than that of other first-line agents, with an estimated microbiological efficacy rate of 80% 1.
Resistance and Susceptibility
- Fosfomycin is active against multidrug-resistant pathogens, including vancomycin-resistant enterococci (VRE), methicillin-resistant S. aureus (MRSA), and extended-spectrum β-lactamase (ESBL)–producing gram-negative rods 1.
- However, susceptibility data are not uniformly available, and testing is not routinely performed in many clinical laboratories 1.
Guidelines and Recommendations
- The Infectious Diseases Society of America (IDSA) and the European Society for Microbiology and Infectious Diseases (ESCMID) recommend Fosfomycin as a first-line agent for the treatment of acute uncomplicated cystitis in women 1.
- The American College of Physicians also recommends Fosfomycin as a single dose for the treatment of uncomplicated bacterial cystitis in women 1.
From the FDA Drug Label
The recommended dosage for women 18 years of age and older for uncomplicated urinary tract infection (acute cystitis) is one sachet of fosfomycin tromethamine granules for oral solution. The recommended dosage of Fosfomycin (Monurol) for the treatment of Urinary Tract Infections (UTI) is one sachet. The recommended frequency is single dose, as the label does not specify multiple doses or a particular frequency. Fosfomycin tromethamine granules for oral solution may be taken with or without food 2.
From the Research
Dosage and Frequency of Fosfomycin for UTI Treatment
- The recommended dosage of Fosfomycin (Monurol) for the treatment of uncomplicated Urinary Tract Infections (UTI) is a single oral dose of 3g 3.
- For complicated UTI, a regimen of 3 grams of oral Fosfomycin administered once every 48 or 72 hours for a total of 3 doses may be used 4.
- In some cases, multiple-dose Fosfomycin regimens, such as 1 dose every 3 days, with a mean duration of 6.1 days, have been used to treat complicated UTI in the outpatient setting 5.
- For intravenous Fosfomycin, a dose of 6 grams every 8 hours for 7 days (or 14 days in patients with concurrent bacteremia) has been used to treat complicated upper urinary tract infections (cUUTI) and acute pyelonephritis (AP) 4.
Special Considerations
- Fosfomycin may be an effective option for treating multidrug-resistant (MDR) UTIs, with a treatment success rate of 55% in one retrospective analysis 6.
- The use of Fosfomycin for MDR UTIs may be associated with factors such as chronic kidney disease, which can increase the risk of persistent infection 6.
- Intravenous Fosfomycin has been studied for the treatment of serious infections, including cUTI, and has shown promise as a potential treatment option 7.