Introduction: In developing nations, urinary tract infections (UTIs) are the most common infectious disease that medical professionals encounter. There is an increasing need to identify new therapy choices. A broad-spectrum antibiotic like Fosfomycin which acts by preventing both gram-positive and gram-negative bacteria from synthesizing their cell walls is one such new option. The purpose of this work is to assess the in vitro susceptibility of urinary Escherichia coli (E coli) isolates to Fosfomycin. Objectives: 1. Isolation and identification of E. coli from urine samples 2. To determine E. Coli isolate pattern of antimicrobial susceptibility in urine 3. To assess the E. coli isolates in-vitro susceptibility to Fosfomycin. Materials and Methods: Every clean catch, midstream urine sample that was collected aseptically in sterile containers received at our lab was taken into consideration. For every urine sample that was received, wet mount was screened. From the urine samples E. Coli isolates were identified using accepted, conventional standard techniques. Petri plates with a colony count of more than 105 CFU per ml of urine were deemed significant in asymptomatic patients whereas count of >104CFU/ml was considered in symptomatic patients and 102 CFU/ml in patients with urethral syndrome. Antimicrobial susceptibility test was conducted using the Kirby Bauer disc diffusion method in accordance with CLSI (2023) recommendations. Results: 427 urine samples were included in the study; 341 of them had significant bacteriuria, and the remaining 86 had no growth or non-significant bacteriuria. 20% of the samples were male, while the remaining 80% were that of females.273 Gram negative isolates and 68 Gram positive isolates were found among the 341 urine bacterial isolates. Among 273 Gram negative isolates 83 were E coli. All E coli isolates were susceptible to Fosfomycin and next to Fosfomycin, there was a greater susceptibility to Nitrofurantoin (83%), followed by Meropenem (73.4%), and then Cotrimoxazole (68.6%). The highest percentage of resistance was for ciprofloxacin (85.5%). Conclusion: Fosfomycin has shown to be a promising treatment for multidrug resistant E coli including ESBL producers and carbapenem-resistant E. coli. The outcomes in our settings were encouraging and promising. It is crucial to follow careful stewardship procedures to stop this medication from becoming resistant.