fosfomycin is Non-Formulary.
A. Criteria for Use
 ➽ Management of acute uncomplicated cystitis (must have documented symptoms and at least
  one of the following:
  • Contraindication to other first-line therapies (e.g., confirmed severe allergy)
  • Cultured organism resistant to other first-line agents (e.g., ESBL or resistant Enterococcus spp.)
  • Documented treatment failure with other first-line agents
B. Recommended Alternatives for Treatment of Acute Uncomplicated Cystitis:
  • nitrofurantoin 100 mg PO BID (if CrCl > 30 mL/min) x 5 days
  • cephalexin 500 mg PO BID x 5 days
  • levoFLOXacin 250 mg daily x 3 days (AVOID unless CrCl ≤ 30 mL/min and confirmed severe penicillin allergy)

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If a provider wants to order fosfomycin and the above criteria are met, he/she must complete a Non-Formulary Drug Request Form and indicate the reason for ordering it. Completed forms should be faxed to the pharmacy (ext 3590) and forwarded to the clinical coordinator for review. fosfomycin Non-Formulary Request Form