Fosfomycin (Monurol®

Fosfomycin (Monurol®)  Fosfomycin (Monurol®)

PO Only Use requires formal ID Consult

Activity: Coverage against many gram-negatives (including ESBL-producing and carbapenem-resistant Enterobacteriaceae [such as E. coli, Klebsiella spp.]) and grampositives (including MRSA and VRE) NOT ACTIVE against Acinetobacter spp.

In the United States only the oral formulation is available. Criteria for Use:

• Management of uncomplicated UTI in patients with multiple antibiotic allergies and/or when no other oral therapy options are available • Uncomplicated UTI due to VRE • Salvage therapy for UTI due to multi-drug resistant organisms (e.g. ESBL, VRE, +/- Pseudomonas; confirm fosfomycin susceptibility prior to initiation of therapy)

Unacceptable Uses:

• Management of any infections outside of the urinary tract. Oral fosfomycin does not achieve adequate concentrations at other sites • Treatment of asymptomatic bacteriuria

Dosing in Adults:

• Standard dose: Uncomplicated UTI: 3 gm (1 sachet) PO once Complicated UTI: 3 gm (1 sachet) PO every 2 to 3 days (up to 21 days of treatment) Powder should be mixed with 90-120 mL of cool water, stirred to dissolve and administered immediately. May be administered with or without food • No renal dose adjustment • No hepatic dose adjustment

Monitoring:

• Signs and symptoms of urinary tract infection

CrCl= Creatinine clearance; ESBL= Extended spectrum beta-lactamase; ID= Infectious Disease; MRSA= Methicillin-resistant Staphylococcus aureus; PO= Oral; Spp= Species; UTI= Urinary Tract Infection; VRE= Vancomycin-resistant enterococci