What is the first-line IV antibiotic for Extended-Spectrum Beta-Lactamase (ESBL) Urinary Tract Infection (UTI)?

From the Guidelines

Intravenous fosfomycin is a recommended first-line treatment for Extended-Spectrum Beta-Lactamase (ESBL) Urinary Tract Infections (UTI), as shown in recent studies 1. The choice of antibiotic for ESBL UTI is crucial due to the resistance patterns of these organisms.

• Key considerations include the severity of the infection, patient comorbidities, and local resistance patterns.
• Fosfomycin has been compared to other antibiotics such as piperacillin-tazobactam and meropenem in clinical trials, showing no significant differences in clinical or microbiological cure rates for patients with ESBL-producing Enterobacterales 1.
• However, it's essential to consider the potential risks, such as the development of heart failure, particularly in patients at risk, as observed in the FOREST trial 1.
• Other options like carbapenems (e.g., meropenem or ertapenem) are also effective but may be reserved for more severe cases or when fosfomycin is not suitable.
• The duration of treatment typically ranges from 7-14 days, depending on the severity of the infection and clinical response.
• For patients with allergies to first-line treatments or specific susceptibility patterns, alternatives like amikacin or oral fosfomycin may be considered, guided by susceptibility testing 1.

From the Research

First-Line IV Antibiotic for ESBL UTI

• The first-line IV antibiotic for Extended-Spectrum Beta-Lactamase (ESBL) Urinary Tract Infection (UTI) is not explicitly stated in the provided studies, but several options are mentioned as effective treatments:
  • Piperacillin-tazobactam (for ESBL-E coli only) 2
  • Carbapenems, including meropenem/vaborbactam, imipenem/cilastatin-relebactam, and sulopenem 2
  • Ceftazidime-avibactam 3, 2
  • Ceftolozane-tazobactam 3, 2
  • Aminoglycosides, including plazomicin 2
  • Fosfomycin 3, 2, 4, 5

Treatment Options for ESBL-Producing Enterobacteriaceae

• Non-carbapenem therapy, such as fosfomycin, pivmecillinam, and nitrofurantoin, may be effective for treating UTIs caused by ESBL-producing Enterobacteriaceae 6, 4, 5
• Oral treatment options, including pivmecillinam, fosfomycin, and nitrofurantoin, may be suitable for uncomplicated UTIs caused by ESBL-producing Enterobacteriaceae 5

Considerations for Treatment

• The choice of antibiotic should be based on the susceptibility pattern of the causative organism and local resistance rates 3, 2
• Antimicrobial stewardship principles should be applied to minimize the development of resistance 3, 2