What oral antibiotics can be used to treat E. coli bacteremia originating from a urinary tract infection?

From the Guidelines

For E. coli bacteremia originating from a urinary tract infection, oral antibiotic options include fluoroquinolones, such as ciprofloxacin 500-750mg twice daily or levofloxacin 750mg once daily, with a recommended treatment duration of 7 days, as suggested by the most recent guidelines 1. When considering oral antibiotics for this condition, it's essential to prioritize medications with excellent bioavailability and tissue penetration.

• Fluoroquinolones are often preferred due to their high oral bioavailability and effectiveness against E. coli, although resistance rates are increasing 1.
• Trimethoprim-sulfamethoxazole (TMP-SMX) is another option, providing good urinary and systemic coverage, but its effectiveness may be reduced against resistant strains 1.
• Third-generation cephalosporins, such as cefpodoxime or cefdinir, can also be considered, but their use should be guided by culture susceptibility results 1. It's crucial to note that these medications are only appropriate for step-down therapy after initial intravenous antibiotics have stabilized the patient and blood cultures show susceptibility to oral agents 1. Patients should be clinically improving with normalized vital signs, negative repeat blood cultures, and the ability to tolerate oral medications before transitioning to oral therapy 1. Antibiotic selection should ultimately be guided by culture susceptibility results, as E. coli resistance patterns vary significantly by region and patient factors 1.

From the FDA Drug Label

1.1 Uncomplicated Urinary Tract Infections Cefixime for oral suspension and cefixime capsule is indicated in the treatment of adults and pediatric patients six months of age or older with uncomplicated urinary tract infections caused by susceptible isolates of Escherichia coli 14.7 Complicated Urinary Tract Infections and Acute Pyelonephritis: 5 Day Treatment Regimen The oral antibiotics that can be used to treat E. coli bacteremia originating from a urinary tract infection are:

• Cefixime (2)
• Levofloxacin (3)

From the Research

Oral Antibiotics for E. coli Bacteremia from Urinary Tract Infections

• The following oral antibiotics can be used to treat E. coli bacteremia originating from a urinary tract infection:
  • Nitrofurantoin 4
  • Fosfomycin 4, 5
  • Pivmecillinam 4
  • Amoxicillin-clavulanate 4, 5
  • Finafloxacin 4
  • Sitafloxacin 4
  • Cephalexin 4
  • Cefixime 4
• However, the use of certain oral antibiotics such as trimethoprim-sulfamethoxazole and ciprofloxacin may be limited due to high rates of resistance 4, 5, 6, 7
• The choice of oral antibiotic should be guided by local susceptibility patterns and the patient's medical history, including previous antibiotic use and resistance patterns 5, 6, 7
• It is essential to use oral antibiotics wisely to avoid the development of resistance 4