What are the oral treatment options for Extended-Spectrum Beta-Lactamase (ESBL) producing Escherichia coli (E. coli) infections?

From the Guidelines

For treating ESBL (Extended-Spectrum Beta-Lactamase) producing E. coli infections orally, fosfomycin (3g single dose for uncomplicated infections or 3g every 48-72 hours for complicated infections) and pivmecillinam (400mg three times daily for 3-5 days for uncomplicated infections) are preferred oral treatment options, with the choice of treatment guided by susceptibility testing and the severity of the infection 1. When considering oral treatment options for ESBL-producing E. coli infections, it is crucial to prioritize the most effective and safest choices to minimize morbidity, mortality, and impact on quality of life.

• The use of carbapenems, although highly effective, is limited to intravenous administration, making them unsuitable for oral treatment 1.
• Fosfomycin and pivmecillinam are recognized for their efficacy against ESBL-producing E. coli in uncomplicated infections, with fosfomycin being particularly notable for its single-dose regimen for uncomplicated urinary tract infections (UTIs) and its potential for use in more complicated infections with adjusted dosing 1.
• Fluoroquinolones, such as ciprofloxacin, may be considered for more severe infections if susceptibility is confirmed, but their use should be cautious due to resistance patterns 1.
• Trimethoprim-sulfamethoxazole is another option for susceptible organisms, with dosing adjusted based on infection severity and site 1. Key considerations in the treatment of ESBL-producing E. coli infections include:
• Susceptibility testing to guide antibiotic choice, given the high resistance rates among ESBL-producing organisms 1.
• The severity and site of the infection, which influence the duration of therapy, with uncomplicated UTIs typically requiring shorter courses (3-7 days) and more complex infections necessitating longer treatment (7-14 days) 1.
• Completing the full course of antibiotics is essential to prevent recurrence and further resistance development, even if symptoms improve 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Oral Treatment Options for ESBL-Producing E. coli Infections

• Fosfomycin, nitrofurantoin, and pivmecillinam are effective oral treatment options for urinary tract infections (UTIs) caused by ESBL-producing E. coli, with susceptibility rates of over 90% 2, 3.
• Cefixime and amoxicillin/clavulanate combination therapy is also an effective oral treatment option for ESBL-producing E. coli, with a synergistic effect observed in vitro and in vivo 4.
• Other oral antibiotics such as cephamycins, fluoroquinolones, and β-lactam/β-lactam inhibitor combinations (e.g. piperacillin/tazobactam) may be considered as alternatives to carbapenems for the treatment of ESBL-producing E. coli infections, although their effectiveness may vary depending on the specific strain and infection severity 5, 6.
• The use of non-carbapenem β-lactams, such as cefepime, ceftolozane-tazobactam, and ceftazidime-avibactam, for the treatment of ESBL infections has yielded conflicting results and requires further study 6.

Specific Oral Antibiotics for ESBL-Producing E. coli Infections

• Fosfomycin: effective against over 90% of ESBL-producing E. coli isolates 2, 3.
• Nitrofurantoin: effective against over 90% of ESBL-producing E. coli isolates 2, 3.
• Pivmecillinam: effective against over 90% of ESBL-producing E. coli isolates 2, 3.
• Cefixime and amoxicillin/clavulanate: effective combination therapy for ESBL-producing E. coli, with a synergistic effect observed in vitro and in vivo 4.
• Cephamycins: may be considered as an alternative to carbapenems for the treatment of ESBL-producing E. coli infections 5.
• Fluoroquinolones: may be considered as an alternative to carbapenems for the treatment of ESBL-producing E. coli infections, although their effectiveness may vary depending on the specific strain and infection severity 5.
• β-lactam/β-lactam inhibitor combinations (e.g. piperacillin/tazobactam): may be considered as an alternative to carbapenems for the treatment of ESBL-producing E. coli infections, although their effectiveness may vary depending on the specific strain and infection severity 5, 6.