Pharmacotherapy

Oral beta-lactams show promise as alternative options for complicated UTIs

February 18, 2026

A systematic review of 17 observational studies (2000–2025) found that select oral β‑lactams achieved >90% clinical success for complicated and bacteremic UTIs when dosed optimally, performing comparably to fluoroquinolones (FQs) and trimethoprim/sulfamethoxazole (TMP‑SMX). Recurrence increased with underdosing, but β‑lactams demonstrated lower adverse event rates (1.3%) vs. fluoroquinolones (2.3%) and TMP‑SMX (5.7%). Agents with higher bioavailability—cephalexin, cefpodoxime, cefuroxime, amoxicillin/clavulanate—demonstrated the most consistent outcomes. Oral β‑lactams were associated with fewer adverse events (1.3%) than FQs (2.3%) or TMP‑SMX (5.7%), though their use may be constrained by factors such as more frequent dosing, inconsistent absorption, and challenges with susceptibility interpretation.

Clinical takeaway: When selecting step‑down therapy for cUTIs, clinicians may consider oral β‑lactams in cases where FQs or TMP‑SMX are unsuitable, while ensuring appropriate dosing and close follow‑up to mitigate risk of treatment failure.

Source:

Kunz Coyne AJ, et al; ACCP Infectious Disease Practice and Research Network (PRN) Research Committee. (2026, February 15). Pharmacotherapy. Oral β-Lactams for Complicated Urinary Tract Infections: A Systematic Review and Point-Counterpoint Comparison With Trimethoprim/Sulfamethoxazole and Fluoroquinolones. https://pubmed.ncbi.nlm.nih.gov/41693075/