UTI Knowledge Center
Antibiotic Spotlight

Fosfomycin

Emery Haley, PhD, Scientific Writing Specialist

Fosfomycin

Find the Latest FDA-Approved Labelling Information Here: Drugs@FDA Online Database

Administrative Routes

Oral (PO)

Other Names

Monurol

Bacteriostatic or Bactericidal

Bactericidal [1]

Antibiotic Class

Phosphonic

Mechanisms of Action

The drug binds to and inhibits the MurA enzyme, which is essential for the formation of peptidoglycan in the bacterial cell wall. Failure of peptidoglycan cell wall synthesis causes bacterial cell death.

WHO AWaRe Classification

Watch (PO) [2]

Empiric Use Recommendations

Yes* (lower UTI/cystitis) [American Urological Association (AUA)] [3]
*Avoid if there are signs/symptoms of early onset pyelonephritis
Avoid if complicated UTI is suspected, as fosfomycin may not achieve adequate levels in renal parenchyma and blood [Infectious Diseases Society of America (IDSA)] [4]

Indication(s) Relevant to UTI

On label for uncomplicated UTIs (acute cystitis) in women caused by Escherichia coli or Enterococcus faecalis.

Checkmarks

CLSI and/or FDA documents support the efficacy of this antibiotic against the following organisms from the Guidance® UTI test: Aerococcus urinae, Escherichia coli, and Enterococcus faecalis.

About the Author

Dr. Emery Haley is a scientific writing specialist with over ten years of experience in translational cell and molecular biology. As both a former laboratory scientist and an experienced science communicator, Dr. Haley is passionate about making complex research clear, approachable, and relevant. Their work has been published in over 10 papers and focuses on bridging the gap between the lab and real-world patient care to help drive better health outcomes.

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References
  1. Ishak, A.; Mazonakis, N.; Spernovasilis, N.; Akinosoglou, K.; Tsioutis, C. Bactericidal versus Bacteriostatic Antibacterials: Clinical Significance, Differences and Synergistic Potential in Clinical Practice. J. Antimicrob. Chemother. 2024, 80, 1–17, doi:10.1093/jac/dkae380
  2. AWaRe Classification of Antibiotics for Evaluation and Monitoring of Use, 2023 Available online: https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2023.04 (accessed on 6 February 2025).
  3. Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2022) – American Urological Association Available online: https://www.auanet.org/guidelines-and-quality/guidelines/recurrent-uti (accessed on 6 February 2025).
  4. Complicated Urinary Tract Infections (CUTI): Clinical Guidelines for Treatment and Management Available online: https://www.idsociety.org/practice-guideline/complicated-urinary-tract-infections/ (accessed on 28 July 2025).