Products
Fosfomycin is commercially available in many countries as granules (Monuril, generics) and has been approved since 1988.
Structure and properties
Fosfomycin is a derivative of phosphonic acid, an epoxide, and is present in the granules as a trometamol salt. Fosfomycin trometamol (C7H18NO7P, Mr = 259.2 g/mol) is a white, hygroscopic powder that is very soluble in water. Fosfomycin is the only member of its drug group. It was isolated from various -species at MSD and CEPA in 1969 and is now produced synthetically.
Effects
Fosfomycin (ATC J01XX01) is bactericidal to proliferating pathogens by inhibiting the first step of bacterial wall synthesis inside cells. The spectrum of activity includes Gram-positive and Gram-negative germs and anaerobes.
Indications
Fosfomycin is used to treat acute, uncomplicated urinary tract infections (e.g., cystitis) and to treat nonsymptomatic bacteriuria. It is also approved for prevention of infections during surgical or diagnostic procedures of the lower urinary tract. It can be used parenterally in numerous other indications but is not approved for this purpose by regulatory authorities in many countries.
Dosage
For treatment, the granules are taken as a single dose on an empty stomach, 2-3 hours before or after eating. For prevention of infectious diseases, it is taken 3 hours before and 24 hours after the procedure. The contents of the sachet are dissolved in water and drunk.
Contraindications
- Hypersensitivity
- Renal insufficiency
- Hemodialysis patients
Full precautions can be found in the drug label.
Interactions
Metoclopramide, antacids, calcium salts, and ingestion with meals reduce plasma concentrations of fosfomycin.
Adverse effects
The most common potential adverse effects include digestive symptoms such as nausea, diarrhea, abdominal pain, vomiting, lack of appetite, and bowel gas discharge. Occasionally, allergic skin reactions, itching, weakness, dizziness, and headache may occur. Severe allergic reactions, on the other hand, are rare.
