Monural granules 3gr #1

Monural instruction for users

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Composition

Drug Monural contains in its composition 3.754 or 5.631 grams of phosphomycin trometamol (which corresponds to 2 or 3 grams of phosphomycin), as well as flavor (tangerine and orange), sucrose and saccharin.

Form of issue

Granules for the preparation of solution for oral administration, packaged in 2 and 3 g in sachets of laminated paper, 1 or 2 bags per pack.

pharmachologic effect

Has a wide spectrum of antimicrobial activity, has a bactericidal effect.
Suppresses the synthesis of the bacterial cell wall (in particular, its first stage).
The specific effect of phosphomycin is manifested in its ability to inactivate enolpyruvil-trasferase, which ensures the absence of cross-drug resistance and excludes the possibility of synergism with other antimicrobial agents (synergism with pipemidic acid, cephalexin, amoxicillin is noted in vitro).

Pharmacodynamics and pharmacokinetics

Is a monural an antibiotic or not?

The action of the active substance of the drug is directed to the destruction and prevention of further multiplication of bacteria that are pathogens of UTI. Consequently, the agent is an antibiotic.

Description of the drug Monural

Antibiotic Monural is available in the form of characteristic white granules. As an active substance in the drug is a derivative of phosphonic acid - phosphomycin. As a structural analogue of phosphoenol pyruvate, the substance exhibits activity against most Gram (+) and Gram (-) bacteria.

Pharmacodynamics

Antibacterial activity of the drug in vitro includes most of the usual Gram (+) microorganisms: enterococci (including fecal), staphylococci (including golden and saprophytic).
Also, the action of the drug is sensitive to Gram (-) pathogens: E. coli, citrobacterium, enterobacteria, Klebsiella (including Klebsiella pneumonia), Proteus mirabilis, Morganella Morgani, Serrations, Pseudomonas.
In vitro agent reduces the adhesion (adhesion) of a number of microorganisms to urothelium.

Pharmacokinetics

When ingestion from the digestive tract is absorbed quickly. In the body it decomposes into trometamol (the substance has no antibacterial activity) and phosphomycin.
Bioavailability of a single dose of Monural 3 g can vary from 34 to 65%. TCmax 2-2.5 h, the C max value is in the range of 22-32 μg / ml. T1 / 2 - 4 h.
Fosfomycin is in a state not connected with plasma proteins, it is not metabolized, accumulates mainly in the urine.
With a single intake of 3 g of the drug in the urine creates a high concentration (from 1.053 to 4.415 g / l), which is 99% bactericidal for most pathogens UTI.
IPC phosphomycin for these pathogens - 128 mg / l. In urine, it is maintained for 24-48 hours, which implies a one-year course of treatment. It is excreted by the kidneys (unchanged). From 18 to 28% of the dose taken in unchanged form is excreted with feces.

Indications for use

Such drugs as Fosfomycin and Monural are used to treat acute attacks of bacterial cystitis (including recurrent), bacterial nonspecific urethritis, asymptomatic massive bacteriuria (including in pregnant women), post-operative UTI.
For preventive purposes, they are prescribed for transurethral diagnostic tests and surgical intervention.

Treatment of cystitis with antibiotics

Cystitis belongs to the category of diseases that, although they do not pose a threat to life, can still cause a lot of suffering to the patient. Symptoms of cystitis, having arisen once, subsequently, as a rule, come back again and again.
The drug Monural is an antibacterial agent of a wide spectrum of action. Unlike bacteriostatic drugs, which can only slow down the growth and reproduction of microorganisms, it provokes the death of bacteria.
The mechanism of action of Monural is realized due to the ability of phosphomycin to disrupt the synthesis of the bacterial cell wall. As a result, the cell development stops and the cell dies.
To date, Monural with cystitis is considered one of the most effective means.
The results of studies conducted in leading clinics of the world confirm its effectiveness in diseases of the urological sphere (the very "one pill from cystitis" that most patients dream about) and the rapid achievement of a good therapeutic effect (the powder should be taken twice).
The antibiotic acts against the causative agents of the cystitis, as well as against the majority of Gram (+) and Gram (-) microorganisms, which makes it possible to use it as an empirical therapy, that is, before the information on the pathogen and its sensitivity to the drug.
Pharmacokinetic features of furomicin contribute to the creation of a long stable concentration of the active substance even after taking a single dose.
In addition, the substance is almost completely removed by the kidneys, which excludes the possibility of developing dysbiosis in the application of Monural. And taking a short course means avoiding the development of resistance of pathogenic microorganisms to it.
The drug is well tolerated and there is no negative effect on fetal development, therefore, the drug Monural against cystitis in women can be used even during pregnancy: in most countries it is one of the drugs of choice in the treatment of asymptomatic bacteriuria and UTI in pregnant women.
Instructions on how to take Monural for cystitis are as follows: for men and women, a single dose of 3 grams is indicated, for children - 2 grams of the drug previously diluted in a third of the glass of water.
In severe cases, adults are allowed to repeat the medication at the same dose after 24 hours.

Application of the drug for pyelonephritis

For the treatment of pyelonephritis, Monural is not used very often. However, the antibacterial effect of the agent is manifested not only in the bladder, but also throughout the urinary tract. And this is what makes it expedient to prescribe it, including with pyelonephritis.
In such cases, the treatment regimen is selected individually, and the drug is used in combination with other drugs.

Contraindications

Contraindications to the appointment of Monural:
    children's age (the product is not used in children under the age of five);
    severe renal failure, which is characterized by a decrease in the Clcr score below 10 ml / min;
    hypersensitivity.

Side effects

Side effects of the drug may manifest as reactions from the digestive tract (diarrhea, nausea, heartburn, vomiting), as well as in the form of hypersensitivity reactions (skin rash, itching).
To eliminate unpleasant phenomena from the gastrointestinal tract, it is usually sufficient to increase the amount of fluid consumed.
Instructions for use Monural (Dosage and Administration)

How to take Monural to adults?

The medication is taken orally, on an empty stomach, after emptying the bladder, better - before going to bed (but not earlier than two hours after dinner). Before taking the contents of the package (for adults - 3 grams) is dissolved in a third of a glass of water.
The course of treatment is 1 day.
Elderly, as well as with a recurrent infection, after 24 hours after the first intake it is recommended to re-drink one more single dose of Monural.
To prevent infection of the urinary tract during surgery or a transurethral diagnostic procedure, the patient is given one single dose 3 hours before and 24 hours after the procedure.
If the patient has a kidney failure, the dose should be reduced, and the intervals between the intake of the solution - increased.

Monural, instruction for use in children

Children's Monument - a two-gram bags with granules. In pediatrics, the drug can be used to treat patients older than five years of age. Single dose - 1 package. You can give the medicine only once.

How much does the Monural work?

An important property of Monural is that with oral intake the maximum concentration in the urine is reached within 3-4 hours, while phosphomycin is characterized by a long half-life (about 48-72 hours).
Due to this stable concentration of active substance is maintained for a long time even after prima 1 dose of the drug.
Feedback indicates that the severity of pain and dysuria is significantly reduced within a few hours after taking the solution.

How often can I take the drug?

To the question "How often can I drink Monural?" Doctors respond as follows: the drug is taken only if there are symptoms of the disease; if the symptoms occur too often (once a month, for example), speech is most likely a chronic form of the disease, and treatment in this case should be selected only on the basis of the results of a comprehensive survey.

Additionally

Despite the abundance of information on the treatment of cystitis with Monural tablets, one should know that neither tablets nor parenteral dosage forms under the Monural brand are manufactured. The only available form of the drug are granules for preparing medicine for oral administration.

Overdose

The risk of an overdose of Monural is minimal.
If there are reasons to assume an overdose, the patient is prescribed forced diuresis and, if necessary, symptomatic treatment.

Interaction

It is not recommended to take Monural in combination with metoclopramide, as the latter contributes to a decrease in the serum phosphomycin concentration and its concentration in the urine.

Storage conditions

The drug can be stored under normal conditions.
Shelf life - Three years.

special instructions

Absorption of phosphomycin is slowed by simultaneous intake of food, because of which the drug should be used 2 hours before or 2 hours after eating.
Patients with diabetes should take into account that the composition of granules Monural includes sucrose. Its concentration in one two-gram packet is 2.1, in the three-gram packet it is 2.213 grams.
The use of broad-spectrum antibiotics (including phosphomycin trometamol) can cause antibiotic-associated (including pseudomembranous) colitis.
Therefore, if the patient experiences severe diarrhea during treatment or after taking Monural, the probability of this diagnosis should be considered.
If it is confirmed, appropriate therapy should be immediately given. Preparations that inhibit peristalsis are contraindicated in such cases.

Monural and alcohol

During drug treatment, alcohol is contraindicated.

Monural during pregnancy and breastfeeding

According to the instructions, during pregnancy, the use of the drug is possible if necessary.
The drug is used exclusively in urological practice, which excludes the emergence of cross-resistance with other antibiotics, meets the safety criteria, has proven microbiological efficacy and, in addition, has successful pharmacokinetics parameters.
Despite the fact that animal studies have not revealed that the drug can cause harm to the fetus, it should be remembered that in the early stages, even safe medications are not welcome.
In the 2nd trimester and in the 3rd trimester, the medication is taken according to the standard scheme: 1 sachet 3 g and then one more - one day after the first intake.
Reviews about Monural at pregnancy confirm the effectiveness of the drug: in uncomplicated form of the disease to eliminate symptoms and their causes, as a rule, only one dose of the drug is sufficient.
If it is necessary to use lactation, breastfeeding should be stopped.

Reviews of Monural

Reviews about Monural on the forums, as well as the doctors' reviews about the drug, indicate the high effectiveness of the agent against the pathogens and its speed.
So, for example, reviews about Monural with cystitis lead to the conclusion that most patients feel a significant improvement already within the first hours after taking the solution.
Undoubted advantages of the drug before analogues are the possibility of using a short course and the absence of serious side effects. The duration of the disease-free period after treatment with Monural is at least 6-12 months.
And yet sometimes patients turn to doctors with a complaint: "The drug did not help, what to do?". If the effect is not noticeable after a single administration of Monural, it may be necessary to take one more single dose. If there is no improvement after this, another reason for the occurrence of unpleasant sensations should be excluded.
And, of course, to completely cure the disease and prevent it from passing into a chronic form, self-medication should be avoided and specialists should be contacted in a timely manner.