Fosfomycin, Treatment of Urinary Tract Infections in Primary Care


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A guideline is intended to assist healthcare professionals in the choice of disease-specific treatments.

Clinical judgement should be exercised on the applicability of any guideline, influenced by individual patient characteristics. Clinicians should be mindful of the potential for harmful polypharmacy and increased susceptibility to adverse drug reactions in patients with multiple morbidities or frailty.

If, after discussion with the patient or carer, there are good reasons for not following a guideline, it is good practice to record these and communicate them to others involved in the care of the patient.

GG&C Primary Care Protocol for Fosfomycin in the Treatment of Urinary Tract Infections

Fosfoymcin prescribing information

  • Particularly active against Multi-Drug Resistant Gram Negative Organisms
  • Often the only orally active agent against these organisms
  • A licensed oral formulation is available in the UK. Prescribe using the brand name (Monuril©).
  • NHSGGC have approved use of Fosfomycin sachets 3g in restricted situations, as recommended by microbiology/infectious


  1. Creatinine Clearance ≤10ml/min
  2. Patients undergoing haemodialysis
  3. Known hypersensitivity to fosfomycin or product excipients
  4. Suspected bacteraemia
  5. Suspected or proven pyelonephritis or peri-nephric abscess


  • Pregnancy or breast feeding (if considering fosfomycin discuss antibiotic choice and dosing with microbiology/infectious
  • Adverse effects: usually do not necessitate stopping fosfomycin. GI problems (e.g. nausea, diarrhoea), headaches,
    vaginitis, skin rashes (self-limiting), rarely hypersensitivity reactions and impairment of liver function.
  • Drug interactions: metoclopramide reduces absorption of fosfomycin: (avoid metoclopramide if possible). Other drugs
    that increase gastrointestinal motility may produce similar effects.

Fosfomycin dosing information

  1. Uncomplicated UTI in non-pregnant adult females – One 3g sachet as a single dose
  2. Lower UTI in adult men – One 3g sachet on day 1 and a further 3g sachet on day 4 (total of 2 doses)*
  3. Catheter-associated UTI in adult men and non-pregnant adult females – One 3g sachet on day 1 with catheter removal/replacement 1 hour after the dose. A further 3g sachet should be taken on day 4 (total of 2 doses)*
    * Off-label dosing

Take fosfomycin on an empty stomach (2-3 hours before a meal or 2 or more hours after a meal), preferably before bedtime and after emptying the bladder. Dissolve the sachet contents in a glass of water and take immediately after preparation.

Last reviewed: 19 May 2021

Next review: 31 May 2024

Author(s): Ysobel Gourlay

Version: 1

Author Email(s): [email protected]

Approved By: Antimicrobial Utilisation Committee