Fosfomycin

Summary

Fosfomycin (CHEMBL1757) is an approved small-molecule antimicrobial agent (ATC S02AA17); indicated across 13 conditions including bacterial infectious disease and urinary tract infection.

At a glance

• Status: Approved (max clinical phase 4)
• Modality: Small molecule
• ATC class: S02AA17 (+1 more)
• Indications: 13 conditions
• Clinical trials: 34
• Chemistry: 138.06 Da · C3H7O4P

Identifiers

Drug identity and classification

Field	Value
ChEMBL ID	CHEMBL1757
Name	Fosfomycin
Type	Small molecule
Max phase	4
FDA approved	yes
PubChem CID	446987
ChEBI	CHEBI:28915
ATC	S02AA17, J01XX01
Molecular formula	C3H7O4P
Molecular weight	138.06
InChIKey	YMDXZJFXQJVXBF-STHAYSLISA-N

SMILES: C[C@H]1[C@H](O1)P(=O)(O)O

IUPAC name: [(2R,3S)-3-methyloxiran-2-yl]phosphonic acid

ChEBI definition: A phosphonic acid having an (R,S)-1,2-epoxypropyl group attached to phosphorus.

Pharmacological roles (ChEBI): antimicrobial agent, EC 2.5.1.7 (UDP-N-acetylglucosamine 1-carboxyvinyltransferase) inhibitor.

Also known as: Calcium fosfomycin, Fosfocina, Fosfomicina, Fosfomycin, Fosfomycin calcium, Fosfomycin calcium hydrate, Fosfomycin sodium, Fosfomycine, J01XX01, NSC-758170, Zti-01, ZTI-01

Parent form; salt/anhydrous children: CHEMBL1200331, CHEMBL1256140, CHEMBL2322189, CHEMBL3188549, CHEMBL4576729

Patent coverage: 5,377 distinct patent families (18,767 SureChEMBL compound mentions), from 1 matched compound structure(s). Mentions count patents naming the compound (not distinct inventions), so promiscuous / reference molecules inflate the mention figure — families are the dedup metric.

Targets

Targets

Broader ChEMBL bioactivity targets: 2 (assay-derived). Sample: UDP-N-acetylglucosamine 1-carboxyvinyltransferase, UDP-N-acetylglucosamine 1-carboxyvinyltransferase.

Bioactivity

ChEMBL activities: 6 potent at pChembl ≥ 5 of 7 total. Top 30 by potency (10 = 0.1 nM, 6 = 1 µM):

Target	pChembl	Type	Value	Unit	Activity ID
P0A749	7	IC50	100	nM	CHEMBL_ACT_12686142
P0A749	6.93	IC50	118	nM	CHEMBL_ACT_1808224
P0A749	6.68	IC50	210	nM	CHEMBL_ACT_25583133
P0A749	5.28	IC50	5300	nM	CHEMBL_ACT_24968616
P0A749	5.17	IC50	6700	nM	CHEMBL_ACT_25952417
P0A749	5.06	IC50	8800	nM	CHEMBL_ACT_18009928

Target pathways

No target-pathway data for this drug (no mapped target genes).

Indications & clinical

Indications

13 indications (1 at ChEMBL trial phase 4). Phase below is the highest clinical-trial phase recorded for this drug against each disease — not the molecule’s overall approval status (that is in the Summary).

Indication	Trial phase	MONDO	EFO
bacterial infectious disease	4	MONDO:0005113	EFO:0000771
urinary tract infection	3	MONDO:0100338	EFO:0003103
gonorrhea	3	MONDO:0004277	DOID:7551
staphylococcus aureus infection	3	MONDO:0005545	EFO:0005681
appendicitis	2	MONDO:0005649	EFO:0007149
bacterial pneumonia	2	MONDO:0004652	EFO:1001272
neoplasm	2	MONDO:0005070	MONDO:0004992
Pseudomonas infection	1	MONDO:0005141	EFO:0001076
pouchitis	1	MONDO:0005312	EFO:0003921
osteomyelitis	0	MONDO:0005246	EFO:0003102

3 further indication records had no mapped disease name (EFO/MeSH-only) or were duplicates, and are omitted.

Clinical trials

Total trials: 34.

Phase distribution

Phase	Trials
PHASE4	11
PHASE3	7
Not specified	6
PHASE1	4
PHASE2	3
PHASE2/PHASE3	1
PHASE1/PHASE2	1
EARLY_PHASE1	1

Top trials by phase / activity

NCT	Phase	Status	Title
NCT06440304	PHASE4	RECRUITING	Therapeutic Options for CRAB
NCT06518291	PHASE4	NOT_YET_RECRUITING	COMPARISON OF NITROFURANTOIN WITH FOSFOMYCIN in TREATING CYSTITIS IN WOMEN
NCT07004049	PHASE4	RECRUITING	Optimising TREATment for Severe Gram-Negative Bacterial Infections
NCT00871104	PHASE4	COMPLETED	Fosfomycin Plus Imipenem for Treatment of Infective Endocarditis
NCT01803191	PHASE4	COMPLETED	Efficacy Study of Prophylaxis With Fosfomycin Versus Ciprofloxacin Prior Prostate Biopsy
NCT01966653	PHASE4	UNKNOWN	Study Comparing Nitrofurantoin to Fosfomycin for Acute Urinary Tract Infection in Women
NCT03151603	PHASE4	COMPLETED	Reducing Antibiotic Use for Uncomplicated Urinary Tract Infection in General Practice by Treatment With Uva Ursi (UU)- a Comparative Effectiveness Trial
NCT03228108	PHASE4	COMPLETED	Culture-guided Antimicrobial Prophylaxis in Men Undergoing Prostate Biopsy.
NCT03260010	PHASE4	UNKNOWN	Efficacy and Safety of Intravenous Fosfomycin in Prosthetic Joint Infection
NCT05211011	PHASE4	UNKNOWN	Efficacy and Safety of Intravenous Fosfomycin in Prosthetic Joint Infection
NCT06659016	PHASE4	COMPLETED	Efficacy of Collagen, Propolis Plus Quercetin (Proqutin®), Bacillus Coagulans, Hyaluronic Acid and Chondroitin Sulphate and D-Mannose to Avoid Symptoms and Prevents Recurrence in Women With Recurrent Urinary Tract Infections
NCT05709028	PHASE3	RECRUITING	Fosfomycin Versus Standard of Care in Children With Antibiotic-resistant Urinary Tract Infections
NCT01898338	PHASE3	COMPLETED	Efficacy of Daptomycin Plus Fosfomycin Versus Daptomycin for Treatment of MRSA Bacteremia
NCT02142751	PHASE3	COMPLETED	Fosfomycin Versus Meropenem or Ceftriaxone in Bacteriemic Infections Caused by Multidrug Resistance in E.Coli
NCT02639520	PHASE3	COMPLETED	Efficacy of CLR Compared to Fosfomycin Trometamol in Acute Lower uUTIs
NCT02753946	PHASE2/PHASE3	COMPLETED	Safety and Efficacy of ZTI-01 (IV Fosfomycin) vs Piperacillin/Tazobactam for Treatment cUTI/AP Infections
NCT03294395	PHASE3	COMPLETED	New AntiBiotic Treatment Options for Uncomplicated Anogenital GOnorrhoea
NCT05254808	PHASE3	TERMINATED	EXtended Use of FOsfomycin for the Treatment of CYstitis in Primary Care
NCT05311254	PHASE3	UNKNOWN	A Trial of Fosfomycin vs Ciprofloxacin for Febrile Neutropenia
NCT03453177	PHASE2	COMPLETED	Intravenous and Oral Fosfomycin in Hospitalised Neonates With Clinical Sepsis
NCT03548129	PHASE2	UNKNOWN	the Use of Fosfomycin as a Single Dose Oral Treatment of Asymptomatic Bacteriuria
NCT03868969	PHASE2	UNKNOWN	Clinical Efficacy of Fosfomycin Trometamol Per os in the Treatment of Documented Male Urinary Tract Infections With ESBL-producing Enterobacteriaceae With ESBL Producing Enterobacteriaceae and Resistance Associated With Fluoroquinolones and Cotrimoxazole (FOSF’HOM)
NCT06017479	PHASE1/PHASE2	COMPLETED	Effectiveness of Single Dose Fosfomycin and Single Dose Levofloxacin as Pre-urodynamic Antibiotic for UTI Prevention
NCT02570074	PHASE1	COMPLETED	PK/PD and Safety/Tolerability of Two Dosing Regimens of Oral Fosfomycin Tromethamine in Healthy Adults
NCT02709265	PHASE1	COMPLETED	Open-Label Phase 1 Study of Aerosolized Amikacin and Fosfomycin in Healthy Volunteers
NCT03709914	PHASE1	UNKNOWN	PK Study of Single-Dose ZTI-01 in Children (<12 Years of Age)
NCT03709927	PHASE1	COMPLETED	4-way Crossover QT Evaluation in Healthy Subjects
NCT03950544	EARLY_PHASE1	UNKNOWN	The Combined Antibiotic Therapy for Carbapenem Resistant Klebsiella Pneumoniae
NCT06814899	Not specified	RECRUITING	Use of Fosfomycin in the Treatment of Bacterial Infections
NCT00976963	Not specified	COMPLETED	Single Dose Monurol for Treatment of Acute Cystitis
NCT03176563	Not specified	COMPLETED	Observational Follow-up Study of REGATTA
NCT04076436	Not specified	UNKNOWN	Efficacy of Intravenous Fosfomycin in the Treatment of Complicated Urinary in Real-life Conditions.
NCT05055544	Not specified	UNKNOWN	Bearberry in the Treatment of Cystitis
NCT05260554	Not specified	COMPLETED	Effect of Cranberry Extract on the Urinary System

Clinical evidence (CIViC)

No CIViC predictive evidence (expected for non-precision-medicine drugs).

Pharmacology

Pharmacogenomics

No CPIC/DPWG dosing guideline or drug-level clinical/variant annotations in PharmGKB for this molecule.

Related molecules

Related molecules

No competitor molecules sharing a primary target (ChEMBL phase ≥2 or PubChem drug-class).