Drug Action
Fosfomycin, a phosphonic acid antibacterial, is active against a range of Gram-positive and Gram-negative bacteria including Staphylococcus aureus and Enterobacteriaceae.
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Drug reference
Fosfomycin, a phosphonic acid antibacterial, is active against a range of Gram-positive and Gram-negative bacteria including Staphylococcus aureus and Enterobacteriaceae.
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Acute uncomplicated lower urinary-tract infections ▶BY MOUTH USING GRANULES ▶Adult: 3 g for 1 dose Prophylaxis of urinary-tract infections in transurethral surgical procedures ▶BY MOUTH USING GRANULES ▶Adult: 3 g, to be given 3 hours before surgery. Dose may be repeated once, 24 hours after surgery Osteomyelitis when first-line treatments are inappropriate or ineffective | Hospital-acquired lower respiratory-tract infections when first-line treatments are inappropriate or ineffective ▶BY INTRAVENOUS INFUSION ▶Adult: 12–24 g daily in 2–3 divided doses (max. per dose 8 g), use the high-dose regimen in severe infection suspected or known to be caused by less sensitive organisms Complicated urinary-tract infections when first-line treatment ineffective or inappropriate ▶BY INTRAVENOUS INFUSION ▶Adult: 12–16 g daily in 2–3 divided doses (max. per dose 8 g) Bacterial meningitis when first-line treatment ineffective or inappropriate ▶BY INTRAVENOUS INFUSION ▶Adult: 16–24 g daily in 3–4 divided doses (max. per dose 8 g), use the high-dose regimen in severe infection suspected or known to be caused by less sensitive organisms
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▶With intravenous use Cardiac insufficiency. elderly (high doses). hyperaldosteronism. hypernatraemia. hypertension. pulmonary oedema
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Doses expressed as fosfomycin base.
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Scottish Medicines Consortium (SMC) decisions SMC No. 1033/15 The Scottish Medicines Consortium has advised (March 2015) that fosfomycin (Fomicyt ®) is accepted for restricted use within NHS Scotland; initiation should be restricted to microbiologists or infectious disease specialists. SMC No. 1163/16 The Scottish Medicines Consortium has advised (September 2016) that fosfomycin trometamol (Monuril ®) is accepted for use within NHS Scotland for the treatment of acute lower uncomplicated urinary tract infections, caused by pathogens sensitive to fosfomycin in adult and adolescent females and for prophylaxis in diagnostic and surgical transurethral procedures.
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GENERAL SIDE-EFFECTS ▶Common or very common Abdominal pain. diarrhoea. headache. nausea. vomiting ▶Uncommon Skin reactions ▶Frequency not known Antibiotic associated colitis SPECIFIC SIDE-EFFECTS ▶Common or very common ▶With oral use Dizziness. vulvovaginal infection ▶Uncommon ▶With parenteral use Appetite decreased. dyspnoea. electrolyte imbalance. fatigue. oedema. taste altered. vertigo ▶Rare or very rare ▶With parenteral use Bone marrow disorders. eosinophilia. hepatic disorders. visual impairment ▶Frequency not known ▶With parenteral use Agranulocytosis. asthmatic attack. confusion. leucopenia. neutropenia. tachycardia. thrombocytopenia
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Manufacturer advises use only if potential benefit outweighs risk.
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Manufacturer advises use only if potential benefit outweighs risk—present in milk.
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▶With oral use Avoid oral treatment if eGFR less than 10 mL/minute/1.73 m2. ▶With intravenous use Use intravenous treatment with caution Infection if eGFR 40–80 mL/minute/1.73 m2 and consult product literature for dose if eGFR less than 40 mL/minute/1.73 m2.
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▶With intravenous use Monitor electrolytes and fluid balance.
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▶With intravenous use For intravenous infusion (Fomicyt ®), give intermittently in Glucose 5% or 10% or Water for Injections; reconstitute each 2-g vial with 50 mL infusion fluid; give 2 g over 15 minutes. ▶With oral use Manufacturer advises granules should be taken on an empty stomach (about 2–3 hours before or after a meal), preferably before bedtime and after emptying the bladder. The granules should be dissolved into a glass of water and taken immediately.
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There can be variation in the licensing of different medicines containing the same drug. Powder for solution for infusion ELECTROLYTES: May contain Sodium ▶Fomicyt (Kent Pharmaceuticals Ltd) Fosfomycin (as Fosfomycin sodium) 2 gram Fomicyt 2g powder for solution for infusion vials | 10 vial P £150.00 Fosfomycin (as Fosfomycin sodium) 4 gram Fomicyt 4g powder for solution for infusion vials | 10 vial P £300.00 Granules CAUTIONARY AND ADVISORY LABELS 9, 13, 23 EXCIPIENTS: May contain Sucrose ▶Fosfomycin (Non-proprietary) Fosfomycin (as Fosfomycin trometamol) 3 gram Fosfomycin 3g granules sachets | 1 sachet P £75.45 DT = £4.86 ▶Monuril (Profile Pharma Ltd) Fosfomycin (as Fosfomycin trometamol) 3 gram Monuril 3g granules sachets | 1 sachet P £4.86 DT = £4.86
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3 g for 1 dose
First-line fragment. Read the complete Indications and Dose section above.
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3 g, to be given 3 hours before surgery. Dose may
First-line fragment. Read the complete Indications and Dose section above.
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12–24 g daily in 2–3 divided doses (max. per
First-line fragment. Read the complete Indications and Dose section above.
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12–16 g daily in 2–3 divided doses (max. per
First-line fragment. Read the complete Indications and Dose section above.
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16–24 g daily in 3–4 divided doses (max. per
First-line fragment. Read the complete Indications and Dose section above.
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