Fosfomycin (Monurol)

Trade name Monurol

Oral agent with a bioavailability 30–37% that varies with food intake.

Is not metabolized and is not protein bound.

Half-life of 5.7 hours.

Excreted unchanged by renal and fecal routes.

An oral broad spectrum antibiotic.

Not recommended for children or adults over age 75 years.

Indicated in the treatment of urinary tract infections.

Usually administered as a single oral dose.

Few side effects.

Associated with the development of bacterial resistance.

Not pref2242ed in patients with severe or recurrent UTI infections.

A bactericidal agent that inhibits bacterial cell wall biogenesis by inactivating the enzyme UDP-N-acetylglucosamine-3-enolpyruvyltransferase, also known as MurA.

Has broad antibacterial activity against both Gram-positive and Gram-negative organisms.

Has activity against E. faecalis, E. coli, and various Gram-negatives like Citrobacter and Proteus.

Because it has greater activity in a low pH, and is predominantly excreted in active form into the urine, it is used for the prophylaxis and treatment of urinary tract infections.

Efficacy against S. saprophyticus, Klebsiella and Enterobacter is variable.

Activity against ESBL producing pathogens, notably ESBL-producing E. coli is good.

Agent is not affected by cross-resistance issues.

Used in uncomplicated UTI, caused by susceptible organisms.

Mutations that inactivate the glycerophosphate transporter render bacteria resistant to fosfomycin.

Enzymes conf2242ing resistance are encoded both chromosomally and on plasmids.

Three related fosfomycin resistance enzymes named FosA, FosB, and FosX are members of the glyoxalase superfamily: FosA and FosX enzymes are produced by Gram-negative bacteria, whereas FosB is produced by Gram-positive bacteria.

These enzymes can render the drug ineffective.

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