Introduction: Urinary tract infections  (UTIs) are amongst the commonest types of bacterial infections worldover. There has been  rapid emergence and spread of resistance amongst Enterobacteriaceae with multidrug resistant  (MDR) and extensively drug resistant  (XDR) uropathogens drastically reducing the number of effective drugs for UTI. Fosfomycin is an old broad–spectrum bactericidal antibiotic agent used in the United States and Europe but sparingly used in India and is not a part of antibiotic recommended for UTI in our National  Antibiotic policy. Aim : To evaluate the antibiotic susceptibility profile of  MDR Enterobacteriaceae (MDRE)  uropathogens and to  assess efficacy of Fosfomycin. Methods: A total of 138  non–duplicate urinary isolates of MDR Enterobacteriaceae were included in the study.Identification and susceptibility testing was done according to standard phenotypic microbiological procedures and AST as per recommendations of CLSI.Results: Total number of urine samples processed were  2476, of which 382  samples  grew significant  Enterobacteriaceae. Of these, 138 isolates were found to be  MDR. The common isolates were  E. coli (60%) followed by Klebsiella pneumoniae (24%). The rates of resistance to drugs recommended as first line – Nitrofurantoin,  trimethoprim–sulfamethoxazole,  Ciprofloxacin, Norfloxacin, were 44%, 67%, 72%,and 77% respectively. Sensitivity to Fosfomycin was highest 94.8% .  Of 17 Imipenem resistant Enterobacteriaceae (Carbapenem–resistant Enterobacteriaceae),  14 were sensitive to fosfomycin. Conclusion: Fosfomycin sensitivity  amongst MDR  uropathogens is highest amongst all antimicrobials with convenience of a single–dose regimen for out patients makes it an ideal option for treating MDR  UTIs. It is recommended that the Fosfomycin should be kept as a reserve drug for treatment of MDR UTIs. There also appears to be an imperative need to include the same in the National Antibiotic Policy guideline.