Fosfomycin (disodium) Intravenous for Adults

Who can administer

May be administered by registered competent doctor or nurse/midwife

Red-light antimicrobial: Requires pre-authorisation from Microbiology or ID prior to use 24 hours/7 days a week (Exception: Oral route of administration).
Note: the vials are labelled as containing 4g in 100ml - however- they actually contain 4g drug powder, which then needs reconstitution and dilution to 100ml
See under 'Dose' for adjustments required in renal impairment
Unlicensed for use in cystic fibrosis
A low sodium diet is recommended during treatment with Fosfomycin (56mmol sodium per 4g dose)

Fomicyt 4g vial

Glucose 5% ONLY (see further information below)

Reconstitute 4g vial with 20ml diluent removed from a 100ml infusion bag
The vial will warm slightly upon reconstitution
Once dissolved, transfer the reconstituted solution to the above infusion bag to produce a 4g in 100ml infusion

Intermittent intravenous infusion

Usual dose

Indication	Daily dose
Cystic fibrosis (unlicensed)^{(ref 1)}	4g every six hours
Complicated urinary tract infection	8g every eight hours
Nosocomial lower respiratory tract infection	8g every eight hours
CPE infection (adults) in combination with other antimicrobials	See page 39 of National Guidelines

Maximum 8g per dose

Elderly patient: Use usual recommended dose. Reduce dose if evidence of renal impairment

Renal impairment FOR CYSTIC FIBROSIS ^{(ref 2)}
Use with GREAT CAUTION in patients with renal impairment. Discuss with Micro/ID/CF consultant before using in any patient with renal impairment.
eGFR (ml/min/1.73m²)	Recommended dose
30 to 40	8g loading dose, then 4g every eight hours
20 to 30	6g loading dose, then 3g every eight hours
10 to 20	4g loading dose, then 2g every eight hours
less than 10	2g loading dose, then 1g every eight hours
Intermittent haemodialysis	2g loading dose, then 2g at the end of each dialysis session

Renal impairment for indications NOT cystic fibrosis
Use with GREAT CAUTION in patients with renal impairment. Discuss with Micro/ID consultant before using in any patient with renal impairment.
eGFR (ml/min/1.73m²)	Recommended dose
30 to 40	8g loading dose, then 8g bd (=70% of dose)
20 to 30	8g loading dose, then 6g bd (=60% of dose)
10 to 20	8g loading dose, then 4g bd (=40% of dose)
less than 10	8g loading dose, then 4g od (=20% of dose)
Intermittent haemodialysis	2g loading dose, and then 2g at the end of each dialysis session
Continuous renal replacement therapy (RRT)	Post-dilution CVVHF - give usual dose. Pre-dilution CVVHF or other forms of RRT: no clinical data

Hepatic impairment: No dosage adjustment necessary

Monitor electrolytes (sodium and potassium) due to sodium content (each 4g dose contains 56mmol sodium)
Monitor fluid balance

Water for Injection can be used as a diluent - however, it may not be practical to administer the drug in 100ml Water for Injection

Store below 25⁰C

Fomicyt SPC December 2024

Antibiotic