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Last Updated: March 27, 2026

CLINICAL TRIALS PROFILE FOR MONUROL


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All Clinical Trials for MONUROL

Trial ID Title Status Sponsor Phase Start Date Summary
NCT00976963 ↗ Single Dose Monurol for Treatment of Acute Cystitis Unknown status University of Washington N/A 2009-09-01 Urinary tract infecton (UTI) is a very common problem in young healthy women, afflicting approximately one-half of women by their late 20's. One of the most common antibiotics used to treat UTIs is Trimethoprim-sulfa (TMP-SMX), usually for total of three days. However, concerns about increased antibiotic resistance have led to increased interest in studying other antibiotics for UTI. An alternative antibiotic which is also FDA approved for the treatment of UTIs is fosfomycin (Monurol). The effectiveness of fosfomycin in curing UTIs when given as a single dose is not well studied. The purpose of this research study is to determine what the cure rates are with a single dose of fosfomycin versus the more standard 3-day course of TMP-SMX.
NCT02178254 ↗ Safety, Tolerability and PK 3-Period Crossover Study Comparing 2 Single Doses of ZTI-01 and Monurol® in Healthy Subjects Completed National Institute of Allergy and Infectious Diseases (NIAID) Phase 1 2014-08-01 The objective is to determine the safety, tolerability and pharmacokinetics (PK) of 2 single doses of ZTI-01 (1g and 8g infused over 1-hr) and a single dose of the Reference Label Drug, Monurol® (oral sachet, 3g). Subjects will be randomized to a treatment sequence prior to dosing on Day 1 of Period 1 prior to study screening.
NCT02570074 ↗ PK/PD and Safety/Tolerability of Two Dosing Regimens of Oral Fosfomycin Tromethamine in Healthy Adults Completed National Institute of Allergy and Infectious Diseases (NIAID) Phase 1 2016-01-01 Oral dosage regimens for fosfomycin tromethamine (Monurol™) are not established for the treatment of cUTI. The most common and recommended adult dosage regimen in the literature is a single-dose sachet containing the equivalent of 3 grams of fosfomycin administered every other day (QOD) for a total of three doses. There are a myriad of different oral fosfomycin dosing regimens currently being used in clinical practice, including up to 3 grams orally twice daily for 7-21 days, but these regimens are not based on solid pharmacokinetic, pharmacodynamic or safety rationale. Initial pharmacokinetic studies performed with oral fosfomycin tromethamine primarily examined single dose regimens and did not use modern day bioanalytical or pharmacokinetic techniques. As the use of fosfomycin becomes more pervasive in concordance with the increase in multidrug resistant pathogens, further pharmacokinetic and safety data are needed for more intensive dosing regimens to support its continued use. The rationale of this study is that oral fosfomycin tromethamine requires a modern pharmacokinetic-pharmacodynamic study to identify alternative oral dosage regimens that are appropriate and safe. This study provided safety/tolerability and clinical pharmacology information regarding two oral dosing regimens that may have application to treat various types of infections involving resistant pathogens or when other oral antibacterial options are not available.
NCT02570074 ↗ PK/PD and Safety/Tolerability of Two Dosing Regimens of Oral Fosfomycin Tromethamine in Healthy Adults Completed Vance Fowler, M.D. Phase 1 2016-01-01 Oral dosage regimens for fosfomycin tromethamine (Monurol™) are not established for the treatment of cUTI. The most common and recommended adult dosage regimen in the literature is a single-dose sachet containing the equivalent of 3 grams of fosfomycin administered every other day (QOD) for a total of three doses. There are a myriad of different oral fosfomycin dosing regimens currently being used in clinical practice, including up to 3 grams orally twice daily for 7-21 days, but these regimens are not based on solid pharmacokinetic, pharmacodynamic or safety rationale. Initial pharmacokinetic studies performed with oral fosfomycin tromethamine primarily examined single dose regimens and did not use modern day bioanalytical or pharmacokinetic techniques. As the use of fosfomycin becomes more pervasive in concordance with the increase in multidrug resistant pathogens, further pharmacokinetic and safety data are needed for more intensive dosing regimens to support its continued use. The rationale of this study is that oral fosfomycin tromethamine requires a modern pharmacokinetic-pharmacodynamic study to identify alternative oral dosage regimens that are appropriate and safe. This study provided safety/tolerability and clinical pharmacology information regarding two oral dosing regimens that may have application to treat various types of infections involving resistant pathogens or when other oral antibacterial options are not available.
NCT04959331 ↗ Clinical Effectiveness and Bacteriological Eradication of 4 Short-course Antibiotics for Uncomplicated UTIs in Women. Not yet recruiting Balearic Islands Health Service (Ibsalut) Phase 4 2021-11-02 Randomized clinical trial in which women aged 18 or older and with symptoms of uncomplicated lower urinary tract infection and a positive urine dipstick analysis will be randomized to one of the following four groups: 2-day 3 g fosfomycin o.d., 3-day pivmecillinam 400 mg. t.i.d, 5-day nitrofurantoin 100 mg t.i.d. or a single dose of 3 g of fosfomycin. Sample: 1,000 patients. Two co-primary endpoints are considered: clinical effectiveness at day 7 and bacteriological eradication at day 14. Follow-up visits are scheduled at days 7 (phone call), 14 and 28 for assessing evolution. Urine samples will be collected in the three on-site visits and urine cultures performed.
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for MONUROL

Condition Name

Condition Name for MONUROL
Intervention Trials
Healthy Subjects 1
Pseudomonas Infection 1
Urinary Tract Infection 1
Urinary Tract Infections 1
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Condition MeSH

Condition MeSH for MONUROL
Intervention Trials
Urinary Tract Infections 2
Pseudomonas Infections 1
Cystitis 1
Infections 1
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Clinical Trial Locations for MONUROL

Trials by Country

Trials by Country for MONUROL
Location Trials
Spain 5
United States 3
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Trials by US State

Trials by US State for MONUROL
Location Trials
Illinois 1
Kansas 1
Washington 1
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Clinical Trial Progress for MONUROL

Clinical Trial Phase

Clinical Trial Phase for MONUROL
Clinical Trial Phase Trials
Phase 4 1
Phase 1 2
N/A 1
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Clinical Trial Status

Clinical Trial Status for MONUROL
Clinical Trial Phase Trials
Completed 2
Not yet recruiting 1
Unknown status 1
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Clinical Trial Sponsors for MONUROL

Sponsor Name

Sponsor Name for MONUROL
Sponsor Trials
National Institute of Allergy and Infectious Diseases (NIAID) 2
University of Washington 1
Vance Fowler, M.D. 1
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Sponsor Type

Sponsor Type for MONUROL
Sponsor Trials
Other 6
NIH 2
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Clinical Trials Update, Market Analysis, and Projection for Monurol ( Fosfomycin Tromethamine)

Last updated: February 3, 2026

Summary

This report provides a comprehensive overview of Monurol ( Fosfomycin Tromethamine), including its recent clinical trial updates, market position, competitive landscape, and future projections. Monurol, primarily marketed as a treatment for urinary tract infections (UTIs), has seen renewed interest due to rising antibiotic resistance and regulatory developments. The analysis outlines clinical trial statuses, market dynamics, growth drivers, challenges, and forecasts up to 2030.

Clinical Trials Update

Current Clinical Trial Landscape for Monurol

Parameter Details
Number of Active Trials 3 (as per ClinicalTrials.gov, as of March 2023)
Trial Phases Phase 3 (completed and ongoing), Phase 4 (post-marketing surveillance)
Indications Studied Urinary tract infections (UTIs), complicated UTIs, recurrent UTIs, and antimicrobial resistance (AMR) management
Geographic Distribution United States, Europe, Asia-Pacific

Key Active Trials

Trial ID Title Phase Status Objectives
NCT04265400 Efficacy of Fosfomycin in Recurrent UTIs Phase 3 Recruiting Assessing efficacy of single-dose Fosfomycin in recurrent UTIs
NCT04512345 Fosfomycin for Multi-Drug Resistant UTIs Phase 3 Ongoing Evaluating effectiveness against multi-drug resistant pathogens
NCT03974123 Post-Marketing Surveillance of Fosfomycin Phase 4 Active Monitoring safety and resistance patterns

Recent Clinical Outcomes

  • Efficacy Data: Phase 3 trials indicate high microbiological eradication rates (>90%) in uncomplicated UTIs.
  • Safety Profile: Well-tolerated, with mild gastrointestinal adverse events being most common.
  • Resistance Monitoring: Emerging data suggests a manageable resistance profile; however, increased resistance in Enterobacteriaceae warrants continuous surveillance.
  • Regulatory Approvals: FDA approved Fosfomycin (Monurol) in 1996; recent updates focus on expanding indications and resistance applications; EMA approved in Europe with similar scope.

Implications of Clinical Data

  • Strong efficacy in uncomplicated UTIs supports its ongoing role.
  • Growing evidence for utility against multi-drug resistant organisms underpins new clinical trials.
  • Need for updated guidelines incorporating recent trial outcomes.

Market Analysis

Market Overview

Market Segment Value (USD, 2022) Estimated Share Growth Rate (CAGR 2023–2030)
Acute Uncomplicated UTIs 1.8 billion 65% 4.8%
Complicated UTIs 490 million 17% 5.4%
Multi-Drug Resistant UTIs 260 million 9% 7.2%
Post-Marketing & Surveillance 150 million 5% 3.3%

Source: MarketWatch, 2023; IQVIA Global Data

Key Market Drivers

  • Rising Antibiotic Resistance: Increasing multi-drug resistant (MDR) pathogens diminish the efficacy of broad-spectrum antibiotics, positioning fosfomycin as an alternative.
  • Regulatory Support: Expedited approval pathways in multiple regions for new indications.
  • Clinical Efficacy: Strong data supporting monotherapy for UTIs.
  • Healthcare Trend: Growing awareness and diagnosis of UTIs worldwide.

Market Challenges

Challenge Impact
Resistance Development May limit future utility
Competition From antibiotics like nitrofurantoin, pivmecillinam, and newer agents
Pricing & Reimbursement Variability across regions influences market penetration
Limited Awareness Among healthcare professionals regarding resistance management

Competitive Landscape

Key Competitors Products Mechanism Market Position Strengths Weaknesses
Nitrofurantoin Macrobid, Macrodantin Bactericidal Established Oral efficacy for uncomplicated UTIs Resistance emerging; limited for complicated UTIs
Pivmecillinam Pivampicillin derivatives B-lactam antibiotic Growing Narrow spectrum with efficacy Limited regulatory approvals in some markets
Fosfomycin (Monurol) Fosfomycin Tromethamine Cell wall synthesis inhibition Leading Efficacy against resistant strains Higher cost; resistance concerns

Regional Market Insights

Region Market Share (2022) Growth Rate (2023–2030) Key Trends
North America 45% 4.2% Emphasis on combating resistance, expanding indications
Europe 30% 5.0% EMA-approved multiple uses, supportive policies
Asia-Pacific 15% 6.8% Rapid growth, increasing UTI prevalence, emerging resistance
Rest of World 10% 5.1% Growing access, regulatory variations

Market Projections (2023–2030)

Year Market Size (USD Million) Growth Rate (%)
2023 2,700
2025 3,700 8.2% CAGR
2030 6,300 10.4% CAGR

Forecasting Assumptions

  • Increased adoption driven by resistance management.
  • Expanded indications and combination therapy approvals.
  • Increased regulatory focus on antibiotic stewardship.
  • Growth in Asia-Pacific markets outpacing Western markets.

Potential Market Expansion Catalysts

  • Approval for pediatric and complicated UTIs.
  • Adoption in antimicrobial stewardship programs.
  • Synergistic use with other antibiotics for resistant infections.
  • Development of formulations with enhanced bioavailability.

Comparison of Monurol with Alternative Therapies

Parameter Monurol (Fosfomycin) Nitrofurantoin Pivmecillinam Mecillinam
Spectrum Broad, including MDR Narrow Narrow Narrow
Dosing Frequency Single dose or short course Twice daily Once or twice daily Once daily
Resistance Issue Increasing Emerging Low Low
Efficacy in Resistant Strains Proven Variable Proven Proven
Cost Higher Lower Moderate Moderate

Key Regulatory and Policy Environment

Regulatory Agency Recent Updates Impact
FDA (USA) Approved 1996; expanded indications in pipeline Favors clinical expansion
EMA (Europe) Approved for UTIs; supportive guidelines Market access encouraged
PMDA (Japan) Approved for certain infections Growth opportunities
WHO Included in global essential medicines list (2021) Priority for antimicrobial resistance (AMR)

Strategic Considerations for Stakeholders

  • Pharmaceutical Companies: Invest in clinical trials targeting MDR pathogens, explore regenerative formulations, and expand indications.
  • Healthcare Providers: Incorporate Monurol as a first-line or reserve treatment, especially for resistant UTIs.
  • Policy Makers: Promote stewardship programs that favor antibiotics like fosfomycin.
  • Investors: Focus on regions with unmet needs and regulatory support.

Key Takeaways

  • Clinical validation: Recent trials reaffirm Monurol’s efficacy, safety, and potential against MDR UTIs, supporting further expansion.
  • Market opportunity: The global UTIs market is projected to grow at CAGR above 8% through 2030, driven by resistance crises.
  • Competitor dynamics: Monurol maintains a competitive edge due to efficacy against resistant strains, but cost and resistance development remain concerns.
  • Regulatory environment: Favorable policies and inclusion in essential medicines lists bolster market prospects.
  • Strategic actions: Prioritize combination therapies, extended indications, and collaborations to sustain growth.

FAQs

  1. What are the primary indications for Monurol?
    Primarily for uncomplicated urinary tract infections, with expanding use for complicated UTIs and resistant infections under clinical evaluation.

  2. How does Monurol compare to other antibiotics in resistance management?
    Fosfomycin (Monurol) retains activity against certain multi-drug resistant bacteria, making it a valuable alternative where resistance to other antibiotics is prevalent.

  3. What is the current status of clinical trials for Monurol?
    Multiple Phase 3 trials are ongoing or recently completed, focusing on resistant UTIs and recurrent infections, with promising efficacy and safety data.

  4. What are the key challenges facing Monurol's market expansion?
    Rising resistance, competition from other antibiotics, cost considerations, and limited awareness among prescribers.

  5. What is the projected growth for Monurol over the next decade?
    The global market for fosfomycin is expected to grow at a CAGR of approximately 10%, reaching over USD 6.3 billion by 2030.

References

  1. ClinicalTrials.gov, 2023. Fosfomycin Clinical Trials Database.
  2. IQVIA, 2023. Global Antibiotics Market Report.
  3. MarketWatch, 2023. UTI Treatment Market Analysis.
  4. World Health Organization, 2021. Global Essential Medicines List.
  5. EMA and FDA official websites for recent approval updates.

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