From the Guidelines
The recommended treatment for Extended-Spectrum Beta-Lactamase (ESBL) Urinary Tract Infection (UTI) is intravenous fosfomycin, which has shown no significant differences in clinical or microbiological cure compared to piperacillin-tazobactam or meropenem in patients with complicated UTI or acute pyelonephritis, including those with bacteraemia, as evidenced by the ZEUS and FOREST trials 1.
When considering treatment options, it's essential to note that:
- Intravenous fosfomycin is a viable option for patients without septic shock, with or without bacteraemia, as shown in the ZEUS and FOREST trials 1.
- Oral fosfomycin can be considered for oral stepdown or outpatient therapy in patients with mostly complicated non-bacteraemic UTI caused by ESBL-producing Enterobacterales, although the evidence is of very low certainty due to the high risk of bias in the observational study 1.
- Aminoglycosides, such as plazomicin, can be used as an alternative, but the risk of nephrotoxicity increases after 7 days of therapy, so shorter durations are recommended 1.
- Carbapenem-sparing treatments, including BLBLI, cephamycins, and cefepime, have shown moderate to low certainty evidence for the treatment of pyelonephritis caused by 3GCephRE, but more research is needed to confirm their effectiveness 1.
In terms of treatment duration:
- Uncomplicated ESBL UTIs typically require 7 days of treatment.
- Complicated UTIs require 10-14 days of treatment.
- Pyelonephritis requires 14 days of treatment.
- Aminoglycoside therapy should be limited to 7 days due to the risk of nephrotoxicity 1.
It's crucial to note that susceptibility testing is essential before finalizing treatment, and patients should complete the full course of antibiotics even if symptoms resolve earlier to prevent recurrence and resistance development.
From the Research
ESBL UTI Treatment
- The recommended treatment for Extended-Spectrum Beta-Lactamase (ESBL) Urinary Tract Infection (UTI) includes carbapenems, which are considered the drug of choice 2.
- However, studies have shown that piperacillin-tazobactam (PTZ) may be an effective alternative to carbapenems for the treatment of nonbacteremic UTIs due to ESBL-producing Enterobacteriaceae 2.
- Ertapenem has also been shown to be effective in treating UTIs caused by ESBL-producing bacteria, and can be administered intravenously or subcutaneously 3, 4, 5.
Treatment Duration
- The duration of treatment for ESBL UTI can vary, but studies have reported the following treatment durations:
Effective Treatment Options
- Carbapenems are considered the first-line agents for severe infections with ESBL-producing bacteria 6.
- Non-carbapenem therapy, such as piperacillin-tazobactam (PTZ) and ertapenem, may be effective alternatives for the treatment of ESBL UTI 2, 3, 4, 5.
- The choice of treatment should be guided by the susceptibility of the causative organism to the initial antimicrobial therapy 6.