Oral β-Lactams for Complicated Urinary Tract Infections: A Systematic Review and Point-Counterpoint Comparison With Trimethoprim/Sulfamethoxazole and Fluoroquinolones - PubMed
6 days ago
- #antimicrobial resistance
- #urinary tract infections
- #beta-lactams
- Rising resistance and toxicity concerns with fluoroquinolones (FQs) and trimethoprim/sulfamethoxazole (TMP/SMX) have prompted interest in oral β-lactams for complicated urinary tract infections (cUTIs).
- A systematic review evaluated the effectiveness, safety, and pharmacokinetic (PK) considerations of oral β-lactams compared to FQs and TMP/SMX for cUTIs.
- Oral β-lactams demonstrated comparable effectiveness to FQs and TMP/SMX, with success rates exceeding 90% when dosed appropriately.
- Recurrence rates were higher with underdosed oral β-lactams.
- Oral β-lactams had lower adverse event rates (1.3%) compared to FQs (2.3%) and TMP/SMX (5.7%).
- Limitations of oral β-lactams include frequent dosing, variable bioavailability, and susceptibility testing challenges.
- Select oral β-lactams can serve as effective alternatives to FQs or TMP/SMX for cUTIs and bacteremic UTI in appropriately selected patients.
- Randomized trials are needed to confirm observational findings and define optimal dosing strategies and shorter treatment durations.