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Monural is an antibiotic used in urology. The preparation is recommended especially in the treatment of urinary tract infections caused, among others, by by gram-positive and gram-negative bacteria. The product is in the form of granules intended to be dissolved in water. In addition, it is possible to combine it with most antibiotics.
Monural — what kind of drug is it?
Monural is an antibiotic that works by killing bacteria that can cause infections. This medicine contains the active substance fosfomycin (as fosfomycin trometamol). Monural is available as granules to be made up into an oral solution (2 grams or 3 grams).
Monural is used in:
- treatment of uncomplicated bladder infections in women and adolescents,
- as part of prophylactic antibiotic therapy in the case of transrectal biopsy of the prostate gland in adult men.
1 sachet contains 3 g of fosfomycin (Fosfomycinum) in the form of 5,631 g of fosfomycin with trometamol (Fosfomycinum trometamolum). Excipient with known effect: sucrose; 1 sachet contains 2,2 g of sucrose.
Read: Home remedies for cystitis
Monural – action
Fosfomycin exerts a bactericidal effect on the proliferating pathogens by preventing the enzymatic synthesis of the bacterial cell wall. Fosfomycin inhibits the first step of intracellular synthesis of the bacterial cell wall by inhibiting peptidoglycan synthesis. Fosfomycin is actively transported into the bacterial cell using two different transport systems (sn-glycerol-3-phosphate and hexose-6 transport systems).
After a single oral dose, the absolute bioavailability of fosfomycin trometamol is approximately 33–53%. Absorption may be slowed down and absorbed by food, but the total amount of active substance excreted in the urine over time is the same.
The mean urinary fosfomycin concentration is maintained above the minimum inhibitory concentration of 128 μg / ml for at least 24 hours after an oral dose of 3 g in both fasted and fed conditions; however, the time to reach the peak concentration in urine is delayed by four hours. Fosfomycin trometamol is involved in the enterohepatic circulation.
Read: Urethral discharge – what does it mean? Treatment of urethritis in men and women
Monural – dosage
The dosage of Monural depends on the patient’s age and state of health. The dosage is as follows:
- acute, uncomplicated cystitis in women and girls (aged> 12 years) – 3 g of fosfomycin at a time,
- perioperative prophylactic antibiotic therapy in the case of transrectal biopsy of the prostate – 3 g of fosfomycin three hours before the start of the procedure and 3 g of fosfomycin 24 hours after the end of the procedure,
Renal impairment – Monural is not recommended for use in people with renal impairment.
Children and youth – the safety and efficacy of Monural in children aged less than 12 years have not yet been established.
In the indication of acute, uncomplicated cystitis in women and girls, the drug should be taken on an empty stomach (about 2-3 hours before a meal or 2-3 hours after a meal), preferably before going to bed and after emptying the bladder.
Monural should be taken orally, the dose should be dissolved in a glass of water and taken immediately after preparation.
Also read: What causes urethral burning?
Monural – contraindications and precautions
The main contraindication to the use of Monural is an allergy to fosfomycin or any of the other ingredients of this drug.
Serious and sometimes fatal hypersensitivity reactions, including anaphylaxis and anaphylactic shock, may occur during treatment with fosfomycin. In the event of such reactions, treatment with fosfomycin should be discontinued immediately and appropriate emergency measures initiated.
Talk to your doctor, pharmacist or nurse before using Monural if you have:
- chronic bladder infections,
- history of diarrhea after taking other antibiotics.
Monural – interactions with drugs and other products
Concomitant use of metoclopramide with Monural reduces serum and urine levels of fosfomycin and should be avoided. Other drugs that increase gastrointestinal motility may have a similar effect.
Food may delay the absorption of fosfomycin leading to a slight reduction in peak plasma and urine concentrations of fosfomycin. Therefore, it is recommended to take the medicinal product on an empty stomach or about 2-3 hours after a meal.
Numerous cases of increased activity of oral anticoagulants have been reported in people treated with antibiotics. Risk factors include severe infection or inflammation, age, and poor general health.
In these circumstances, it is difficult to determine whether the change in INR was due to the infectious disease or its treatment. However, some classes of antibiotics are more likely to cause changes in the INR value than others, in particular: fluoroquinolones, macrolides, cyclins, cotrimoxazole and some cephalosporins.
Monural – side effects
Like all medicines, Monural can cause side effects, although not everybody gets them.
Stop taking the medicine immediately and contact your doctor if you experience any of the following symptoms while taking Monural:
- anaphylactic shock, a type of life-threatening allergic reaction (frequency unknown). Symptoms include sudden onset of a rash, itching or hives on the skin or shortness of breath, wheezing or difficulty breathing.
- swelling of the face, lips and tongue or throat and difficulty breathing
- angioedema (frequency unknown)
- moderate to severe diarrhea, abdominal cramps, bloody stools and / or a fever may be a colon infection – antibiotic colitis (frequency not known). Medicines for diarrhea that reduce intestinal motility (anti-peristaltic drugs) must not be taken.
Other side effects Common (may affect up to 1 in 10 people):
- Headache,
- dizziness,
- diarrhea,
- nausea,
- indigestion,
- abdominal pain,
- infection of the female genital organs manifested by inflammation, irritation, itching (vulvovaginitis).
Uncommon (may affect up to 1 in 100 people):
- vomiting,
- rash,
- hives
- itch.