Fosfomycin

Mode of Action Bactericidal Inhibits first step of bacterial cell

wall synthesis
Indications Acute uncomplicated  Enterobacteriaceae Second line (oral)
cystitis in females o Inc E coli
 E faecalis
Bacterial infections  Complicated UTI When other agents are either
due to susceptible  Osteomyelitis unsuitable or ineffective (IV)
organisms
Contraindications Sachet contains 2.2g Avoid in
sucrose  Hereditary fructose
intolerance
 Glucose-galactose
malabsorption
 Sucrose-isomaltase
insufficiency
Renal Is predominantly renally cleared Manufacturer states C/I in
CrCl<10mL/min
Pregnancy Single dose doesn’t increase risk Only use when other drugs are
of congenital malformations unsuitable

Breastfeeding Small amounts pass into breast No human data available

milk  Single dose likely safe
 May cause loose
bowels in baby
Adverse effects Common (>1%)  Diarrhoea
 Nausea
Infrequent (0.1-1%)  Parasthesias Usually circum-oral
Rare ((<0.1%)  Hypersensitivity
reactions
o Anaphylaxis
o Angioedema
o Rash
 Taste disturbance
Dosage Oral 3g single dose Females >12yrs age

Counselling Mix sachet contents in water and drink immediately

Works best if taken before bed after emptying bladder
Is less effective for Avoid taking these on same day or within 2 days after taking
UTIs if taken at same fosfomycin
time as
 Sodium bicarb
 Ural
 Citralite
 Citravescent
Effective urinary concentrations achieved regardless of timing around food
NOTES Injection not available May be able to access through SAS
in Australia
Is not suitable for Oral administration is unlikely to achieve necessary systemic
pyelonephritis concentration
https://amhonline.amh.net.au.acs.hcn.com.au/chapters/anti-infectives/antibacterials/other-antibacterials/fosfomycin?
menu=home