Fosirol Powder 3G

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What is Fosirol Powder 3G?

Fosirol Powder 3G is a brand of fosfomycin trometamol 3 g as a single-dose oral sachet (granules to be dissolved in water before drinking). Fosfomycin trometamol is the standard outpatient formulation for uncomplicated cystitis. Internationally branded as Monurol (US, EU), Monuril (UK, EU), Urinex, Fosmidex. Pack sizes available at MedsBase: 3, 6 or 9 sachets.

Fosfomycin has been in clinical use since 1988 and remains first-line guideline therapy for uncomplicated lower UTI in women in most modern infectious-disease guidelines (IDSA, EAU, NICE), thanks to its single-dose convenience, excellent activity against the dominant uropathogens (especially E. coli och Enterococcus faecalis), and unusually low resistance rates — including against multi-drug-resistant (MDR) organisms.

How fosfomycin works

Fosfomycin is a bactericidal antibiotic with a unique mechanism: it inhibits MurA (UDP-N-acetylglucosamine enolpyruvyl transferase), an enzyme catalysing the very first committed step of bacterial peptidoglycan cell-wall synthesis. This is upstream of the targets of penicillins, cephalosporins, and carbapenems — which is why fosfomycin retains activity against beta-lactam-resistant organisms.

After oral dosing, fosfomycin is rapidly absorbed (bioavailability ~40%) and is excreted primarily in the urine, achieving very high concentrations in bladder urine for 24-48 hours after a single 3 g dose. This is why a single dose is sufficient for uncomplicated lower UTI — the urinary concentrations exceed the MIC of typical uropathogens for the entire treatment window.

When fosfomycin is used

• Uncomplicated acute lower urinary tract infection (cystitis) in women — the licensed and most common use. First-line per IDSA, EAU and NICE guidelines.
• Asymptomatic bacteriuria in pregnancy — selected cases (Pregnancy Category B; safe in all trimesters)
• Single-dose UTI prophylaxis for transurethral procedures (cystoscopy, prostate biopsy)
• Multi-drug-resistant urinary tract infections — ESBL-producing E. coli, vancomycin-resistant enterococci (VRE) urinary infections; off-label use as oral salvage therapy
• UTI in patients allergic to or unable to take other first-line antibiotics (penicillin allergy, sulfa allergy, fluoroquinolone restriction)

Fosfomycin is NOT generally used for: pyelonephritis (poor renal-tissue penetration), prostatitis (poor prostatic-tissue penetration), upper UTI, or systemic infection — for these, intravenous antibiotics or a different oral agent are required.

How to take Fosirol Powder 3G

1. Empty the contents of one sachet into 1/2 to 1 glass (about 75-100 mL) of cool water. Do not use hot water.
2. Stir until fully dissolved — the granules dissolve in seconds
3. Drink the entire glass immediately
4. Ta på fastande mage (at least 2 hours after a meal, or 1 hour before)
5. Ideally take before bedtime, after emptying the bladder — this maximises drug residence time in urine overnight
6. Do NOT take with food, antacids, or magnesium / aluminium / calcium supplements — these reduce absorption substantially
7. Drink plenty of fluids over the next 24 hours to maintain a good urine flow

Symptom improvement is typically noticeable within 24-48 hours. If symptoms are not improving within 48 hours of dosing, see your doctor — the infection may be caused by a fosfomycin-resistant organism, may be a complicated UTI, or you may have a different diagnosis (interstitial cystitis, sexually-transmitted infection, urinary stone).

Repeat dosing: for selected indications (recurrent UTI prophylaxis, complicated UTI), some prescribers use a 3-dose regimen (3 g every 48-72 hours for 3 doses). Do NOT repeat-dose without medical advice.

Pregnancy: fosfomycin is one of the safest UTI antibiotics in pregnancy and is commonly used in all three trimesters. Standard 3 g single dose.

Barn: generally not used in children under 12; alternative paediatric antibiotics preferred.

Biverkningar & säkerhet

• Vanliga (1 av 10): diarrhoea (often mild and self-limiting), nausea, headache, dizziness, vaginitis
• Mindre vanliga: abdominal pain, dyspepsia, rash, urticaria, fatigue
• Sällsynt: Stevens-Johnson syndrome, anaphylaxis, optic neuritis, aplastic anaemia, Clostridioides difficile colitis (less common than with broad-spectrum beta-lactams or fluoroquinolones)

Kontraindikationer & varningar

Do not take fosfomycin if you have:

• Known hypersensitivity to fosfomycin or any of the sachet excipients
• Severe renal impairment (eGFR <10 mL/min) — fosfomycin is renally cleared and accumulates
• Children under 12 years (limited paediatric data; alternative antibiotics preferred)

Använd med försiktighet om du har: severe hepatic impairment (limited data), prior C. difficile colitis, sodium-restricted diet (each sachet contains some sodium).

Läkemedelsinteraktioner

• Metoclopramide and other prokinetics — reduce fosfomycin absorption; avoid co-administration
• Antacids, magnesium, aluminium, calcium supplements — reduce absorption; separate by at least 2 hours
• Food — reduces absorption; take on an empty stomach
• Hormonella preventivmedel — no clinically significant interaction (unlike with rifampicin, etc.)

Fosfomycin vs other UTI antibiotics

Recurrent UTI and resistance considerations

Recurrent UTI (defined as >2 episodes in 6 months OR >3 in 12 months) requires more than repeated antibiotic courses:

• Get a urine culture — identify the actual organism and its susceptibility profile
• Address modifiable risk factors — sexual activity (postcoital antibiotic prophylaxis), inadequate fluid intake, voiding behaviours, diaphragm/spermicide contraception, postmenopausal vaginal atrophy (topical vaginal oestrogen reduces UTI rate substantially)
• Consider non-antibiotic prophylaxis — D-mannose 2 g daily, vaginal probiotics (Lactobacillus), cranberry products (modest evidence), methenamine hippurate (for some patient groups)
• Antibiotic prophylaxis if non-pharmacological measures fail — low-dose nitrofurantoin or trimethoprim taken at bedtime, or postcoital prophylaxis
• Investigate for underlying cause if >6 UTIs per year, complicated UTI, or pyelonephritis — structural urological imaging, post-void residual measurement, urological referral

Resistance to fosfomycin remains very low globally (1-3% in most settings), even against MDR organisms. Repeated empirical use without culture should still be avoided to preserve this favourable resistance profile.

Förvaring & hållbarhet

Store Fosirol Powder 3G sachets below 30°C in the original packaging. Protect from moisture. Keep out of reach of children. Use immediately after opening the sachet (the granules in solution should be drunk within minutes of mixing). Do not use after the expiry date.

Vanliga frågor

How quickly will I feel better after a fosfomycin sachet?

Symptom improvement is typically noticeable within 24-48 hours of the single dose. If symptoms have not improved by 48 hours, see your doctor — the infection may be caused by a fosfomycin-resistant organism, may need a different antibiotic, or you may have a different diagnosis (interstitial cystitis, STI, kidney stone).

Why is it taken on an empty stomach?

Food significantly reduces fosfomycin absorption (up to 50% reduction in bioavailability). Taking it on an empty stomach — at least 2 hours after a meal, or 1 hour before — maximises drug delivery to the urinary tract. Bedtime dosing on an empty stomach after emptying the bladder gives the longest residence time of high drug levels in urine.

Can I take a second dose if I am still symptomatic?

Do not self-prescribe a repeat dose — if symptoms persist beyond 48 hours, see your doctor for assessment. The right next step depends on the cause: a different antibiotic if culture shows resistance, a longer course for complicated UTI, or investigation for pyelonephritis or other diagnosis. A second 3 g dose at 72 hours is appropriate for selected indications under medical supervision.

Is fosfomycin safe in pregnancy?

Yes — fosfomycin is one of the safest UTI antibiotics in pregnancy and is commonly used in all three trimesters. Single 3 g dose. Avoid nitrofurantoin near term (last trimester, especially close to delivery, due to neonatal haemolysis risk in G6PD deficiency).

Can I drink alcohol with fosfomycin?

No specific alcohol interaction. However, alcohol is a bladder irritant and dehydrating — avoid heavy alcohol while symptomatic from a UTI. Drink plenty of water in the 24-48 hours after dosing.

Will fosfomycin work for my partner’s UTI symptoms (man)?

Fosfomycin is licensed for uncomplicated cystitis in women. UTI in adult men is, by definition, COMPLICATED — it is uncommon in young men and almost always associated with anatomical abnormality, prostatitis, or bladder outlet obstruction. Men with UTI symptoms need a 7-14 day antibiotic course (typically with a fluoroquinolone or trimethoprim-sulfamethoxazole) and a doctor’s evaluation. Single-dose fosfomycin is not adequate for male UTI.

Does fosfomycin cause Clostridioides difficile (C. diff) colitis?

Fosfomycin has a much lower C. difficile risk than the broad-spectrum beta-lactams or fluoroquinolones, because it has a narrow spectrum and minimal effect on the gut anaerobes that maintain colonisation resistance. C. diff has been reported with fosfomycin but is uncommon.

What if I am allergic to penicillin?

Fosfomycin has no structural relationship to penicillins or cephalosporins and does not cross-react. It is a good choice for UTI treatment in patients with confirmed penicillin allergy.

Where can I order Fosirol Powder 3G online?

You can order Fosirol Powder 3G 3 g sachets from MedsBase in pack sizes of 3, 6 or 9 sachets. Orders ship worldwide with discreet packaging. Fosfomycin is specialist-supervised in most countries.

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