fosfomycin
Fosfomycin (also known by its brand name, Monurol) is an antibiotic that's used for treating urinary tract infections (UTIs) in women, including those who are pregnant. It's a powder that's mixed with water before it's taken by mouth. Fosfomycin (Monurol) is a convenient option because you only need to take one dose to treat your infection and it doesn't have many drug interactions. Side effects include diarrhea, nausea, and headache.
What is Fosfomycin (Monurol)?
What is Fosfomycin (Monurol) used for?
Urinary tract infections (UTIs) in women
How Fosfomycin (Monurol) works
Fosfomycin (Monurol) is a urinary antibiotic. It kills bacteria by preventing them from being able to build their own protective covering.
Drug Facts
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What are the side effects of Fosfomycin (Monurol)?
Common Side Effects
- Diarrhea (9%)
- Vaginal inflammation (pain, redness, swelling, warmth; 6%)
- Nausea (4%)
- Headache (4%)
Other Side Effects
- Dizziness
- Lack of energy
- Upset stomach
Serious Side Effects
- Allergic reactions: hives; rash; blisters; swelling of the lips, tongue, or face; difficulty breathing
- Infectious diarrhea (C. difficile-related diarrhea): foul-smelling diarrhea, fever, nausea, frequent bowel movements (up to 15 times per day)
Source:Â DailyMed
More on Fosfomycin (Monurol) side effects
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Rare
Blood in the urine
burning while urinating
cough or hoarseness
difficult or painful urination
fever or chills
lower back or side pain
painful or difficult urination
Incidence not known
Abdominal or stomach pain or tenderness
black, tarry stools
clay-colored stools
dark urine
difficulty with swallowing
dizziness
fast heartbeat
headache
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
light-colored stools
loss of appetite
nausea or vomiting
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
rash
severe abdominal or stomach cramps and pain
shortness of breath
sores, ulcers, or white spots on the lips or in the mouth
swollen or painful glands
tightness in the chest
unpleasant breath odor
unusual bleeding or bruising
unusual tiredness or weakness
vomiting of blood
watery and severe diarrhea, which may also be bloody
worsening of asthma
yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Itching of the vagina or genital area
pain during sexual intercourse
thick, white vaginal discharge with no odor or with a mild odor
Less common
Acid or sour stomach
back pain
belching
body aches or pain
congestion
dryness or soreness of the throat
indigestion
lack or loss of strength
runny or stuffy nose
skin rash
stomach discomfort or upset
tender, swollen glands in the neck
trouble with swallowing
voice changes
weakness
Rare
Abnormal stools
absent missed or irregular menstrual periods
blindness
blue-yellow color blindness
blurred vision
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
decreased vision
difficulty with moving
excess air or gas in the stomach or intestines
full feeling
headache, severe and throbbing
joint pain
loss of appetite
muscle aching or cramping
muscle pains or stiffness
nervousness
passing gas
sleepiness or unusual drowsiness
stopping of menstrual bleeding
swollen joints
swollen, painful, or tender lymph glands in the neck, armpit, or groin
trouble sleeping
unable to sleep
Incidence not known
Hearing loss
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Fosfomycin (Monurol)
Pros
Works well at treating UTIs, including those caused by resistant bacteria that are hard to treat with other antibiotics
Only need to take one dose to treat a UTI
Can use if you have kidney or liver problems
Cons
Can cause diarrhea
Only used to treat UTIs that don't have complications
Hasn't been studied in children age 12 years and younger
Pharmacist tips for Fosfomycin (Monurol)
To take fosfomycin (Monurol), mix the powder inside one packet with 3 to 4 ounces (half a cup) of cool water and drink right away. Don't mix with hot water because this can damage the medication and make it not work well to treat your infection. To make sure you get the entire dose, add a little more water to the same glass to get any powder residue left, swirl gently, and drink right away.
Take fosfomycin (Monurol) with or without food. But taking it with food could help prevent stomach-related side effects (e.g., diarrhea, nausea).
Your symptoms should get better in about 2 to 3 days after you take fosfomycin (Monurol). Tell your healthcare provider if you don't feel better after 3 days.
Diarrhea is a common side effect of fosfomycin (Monurol) and is typically mild. But seek medical help right away if you develop watery or bloody diarrhea, fever, fatigue, or stomach cramps anytime during treatment or after stopping fosfomycin (Monurol). These could be signs of a type of serious infectious diarrhea that needs to be treated quickly.
Let your provider know if you take metoclopramide (Reglan) because it can affect how well fosfomycin (Monurol) is absorbed into your body. Since fosfomycin (Monurol) is just one dose, you'll probably just need to separate when you take these medications.
Frequently asked questions about Fosfomycin (Monurol)
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What are the risks and warnings for Fosfomycin (Monurol)?
Fosfomycin (Monurol) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Diarrhea from Clostridioides difficile infection
Antibiotics, including fosfomycin (Monurol), can raise your risk of getting infected with a bacteria called Clostridioides difficile (C. diff). This infection can cause diarrhea that can sometimes be life-threatening. Antibiotics change the amount of normal bacteria in your stomach and intestines. This can cause C. diff to overgrow in your gut and lead to an infection.
It's important to recognize the difference between diarrhea as a side effect of fosfomycin (Monurol) and this type of infectious diarrhea. C. diff-related diarrhea can cause rapid heart rate, foul-smelling diarrhea, fever, nausea, frequent bowel movements (even up to 15 times per day) and is an emergency. Contact a provider right away if you experience any of these symptoms to get tested for C. diff infection and receive treatment if needed.
Fosfomycin (Monurol) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 3g | 1 packet | $32.51 | $32.51 |
Typical dosing for Fosfomycin (Monurol)
The typical dose is 3 grams (1 sachet or packet) mixed with about a half cup of water and taken by mouth once.
Interactions between Fosfomycin (Monurol) and other drugs
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Cholera Vaccine, Live
How much does Fosfomycin (Monurol) cost?
What are alternatives to Fosfomycin (Monurol)?
Urinary tract infections (UTIs) in women
Treatment or prevention of urinary tract infections
Lower respiratory tract infection (e.g., Pneumocystis pneumonia, infections related to bronchitis)
Travelers' diarrhea - tablet or liquid only
Ear infections - tablet or liquid only
What is the latest news about Fosfomycin (Monurol)?
Fosfomycin (Monurol) images
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References
Best studies we foundAmerican College of Obstetricians and Gynecologists’ Committee on Clinical Consensus-Obstetrics. (2023). Urinary tract infections in pregnant individuals. The American College of Obstetricians and Gynecologists.
Bouiller, K., et al. (2022). Efficacy and safety of oral fosfomycin-trometamol in male urinary tract infections with multidrug-resistant Enterobacterales. Antibiotics.
Konwar, M., et al. (2022). Evaluation of efficacy and safety of fosfomycin versus nitrofurantoin for the treatment of uncomplicated lower urinary tract infection (UTI) in women - A systematic review and meta-analysis. Journal of Chemotherapy.
Sojo-Dorado, J., et al. (2022). Effectiveness of fosfomycin for the treatment of multidrug-resistant Escherichia coli bacteremic urinary tract infections: A randomized clinical trial. Journal of the American Medical Association Network Open.
Tamma, P. D., et al. (2022). Infectious Diseases Society of America 2023 guidance on the treatment of antimicrobial resistant gram-negative infections. Clinical Infectious Diseases.
ten Doesschate, T., et al. (2022). Fosfomycin vs ciprofloxacin as oral step-down treatment for Escherichia coli febrile urinary tract infections in women: A randomized, placebo-controlled, double-blind, multicenter trial. Clinical Infectious Diseases.
Zambon USA, Ltd. (2023). Fosfomycin tromethamine powder [package insert]. DailyMed.
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