Drug reference

Fosfomycin

Antibacterial

CDSCO approved

EXCRETION

—

not curated

INTERACTIONS

—

none in our sources

PREGNANCY

Manufacturer advises use only if potential benefit outweighs risk.

FDA category + note

Mechanism

Fosfomycin inhibits a very early stage of bacterial cell wall synthesis by acting as a phosphoenolpyruvate analog. It irreversibly inactivates the cytoplasmic enzyme enolpyruvate transferase through covalent binding to its active site. This action blocks the crucial step of adding phosphoenolpyruvate to UDP-N-acetylglucosamine, thereby preventing peptidoglycan precursor formation and exerting its bactericidal effect.

Indications

Acute uncomplicated lower urinary-tract infectionsProphylaxis of urinary-tract infections in transurethral surgical proceduresOsteomyelitis when first-line treatments are inappropriate or ineffectiveHospital-acquired lower respiratory-tract infections when first-line treatments are inappropriate or ineffectiveBacterial meningitis when first-line treatment ineffective or inappropriateAcute uncomplicated cystitisProstatitis (for pathogens resistant to other oral agents)

Dosing

Adult: Oral: For acute uncomplicated lower urinary-tract infections, 3 g as a single dose. For prophylaxis of urinary-tract infections in transurethral surgical procedures, 3 g given 3 hours before surgery, may be repeated once 24 hours after surgery.…
Renal adjustment: Oral: Avoid if eGFR less than 10 mL/minute/1.73 m2. Intravenous: Use with caution if eGFR 40–80 mL/minute/1.73 m2; consult product literature for dose if eGFR less than 40 mL/minute/1.73 m2.
Max dose: 24 g daily (with a maximum of 8 g per dose for intravenous administration)