{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T15:37:03Z","timestamp":1791387423441,"version":"4.3.3"},"reference-count":60,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,2,15]],"date-time":"2026-02-15T00:00:00Z","timestamp":1771113600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,15]],"date-time":"2026-02-15T00:00:00Z","timestamp":1771113600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Rising resistance and toxicity concerns with fluoroquinolones (FQs) and trimethoprim\/sulfamethoxazole (TMP\/SMX) have prompted interest in oral \u03b2\u2010lactams as alternatives for complicated urinary tract infections (cUTIs). This review evaluates the effectiveness, safety, and pharmacokinetic (PK) considerations of oral \u03b2\u2010lactams compared to FQs and TMP\/SMX in these clinical contexts. A structured point\u2010counterpoint discussion explores their role in antimicrobial stewardship and patient\u2010centered therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic PubMed search identified studies published between January 2000 and December 2025. Eligible studies included randomized trials and observational cohort studies evaluating clinical effectiveness, microbiological outcomes, or safety of oral \u03b2\u2010lactams for cUTIs or bacteremic UTI compared with FQs or TMP\/SMX. Outcomes of interest included treatment success, recurrence, adverse events, and PK considerations. Excluded studies involved special populations, nontraditional agents, or infections outside the scope of cUTI. Data were synthesized narratively due to heterogeneity in study design and outcome reporting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seventeen observational studies met the inclusion criteria. Oral \u03b2\u2010lactams demonstrated comparable effectiveness to FQs and TMP\/SMX for cUTIs, including bacteremic UTI, when dosed appropriately. Oral \u03b2\u2010lactams with high oral bioavailability (e.g., cephalexin, cefpodoxime, cefuroxime, amoxicillin\/clavulanate), showed success rates exceeding 90%, but recurrence was higher when underdosed. Oral \u03b2\u2010lactams had lower adverse event rates (1.3%) compared to FQs (2.3%) and TMP\/SMX (5.7%), but may carry limitations including frequent dosing, variable bioavailability, and susceptibility testing challenges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although not traditionally recognized as first\u2010line therapy, select oral \u03b2\u2010lactams demonstrated effectiveness comparable to FQs or TMP\/SMX for cUTIs and bacteremic UTI and can serve as effective alternatives in appropriately selected patients. When optimally dosed, these \u03b2\u2010lactams achieve comparable outcomes with favorable safety profiles and antimicrobial stewardship advantages. Randomized trials are needed to confirm these observational findings and to better define optimal dosing strategies and shorter treatment durations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/phar.70118","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T05:20:17Z","timestamp":1771219217000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Oral \u03b2\u2010Lactams for Complicated Urinary Tract Infections: A Systematic Review and Point\u2010Counterpoint Comparison With Trimethoprim\/Sulfamethoxazole and Fluoroquinolones"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4891-8625","authenticated-orcid":false,"given":"Ashlan J.","family":"Kunz Coyne","sequence":"first","affiliation":[{"name":"University of Kentucky, College of Pharmacy  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0626-9695","authenticated-orcid":false,"given":"Jeannette","family":"Bouchard","sequence":"additional","affiliation":[{"name":"Duke Antimicrobial Stewardship Outreach Network (DASON)  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6448-3879","authenticated-orcid":false,"given":"Spencer H.","family":"Durham","sequence":"additional","affiliation":[{"name":"Auburn University, Harrison College of Pharmacy  Auburn Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3619-8904","authenticated-orcid":false,"given":"Amy Y.","family":"Kang","sequence":"additional","affiliation":[{"name":"Chapman University, School of Pharmacy  Irvine California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7733-8690","authenticated-orcid":false,"given":"Kinsey M.","family":"Johannemann","sequence":"additional","affiliation":[{"name":"Huntsville Hospital  Huntsville Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5385-354X","authenticated-orcid":false,"given":"W. 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