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Although not standard therapy, azithromycin (AZM) displayed potent activity against ESBL E. coli in vitro, ex vivo, and in vivo. AZM demonstrated multi-fold reductions in MIC, bactericidal activity in supplemented mammalian tissue culture media, and enhanced dose-dependent activity with sodium bicarbonate (NaHCO3). AZM also augmented complement-mediated killing in human serum and improved survival by 50% in a murine bloodstream infection model. These findings underscore the need to revisit antibiotic susceptibility testing\u2014incorporating host defense factors and NaHCO3\u2014and suggest AZM merits further clinical evaluation for ESBL E. coli infections.<\/jats:p>","DOI":"10.1093\/infdis\/jiaf480","type":"journal-article","created":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T11:37:22Z","timestamp":1758022642000},"page":"70-75","source":"Crossref","is-referenced-by-count":2,"title":["Investigating Azithromycin Activity Against ESBL-Producing\n                    <i>Escherichia coli<\/i>\n                    Under Physiologically Relevant Conditions"],"prefix":"10.1093","volume":"233","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0675-9407","authenticated-orcid":false,"given":"Sean","family":"Jung","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases and Global Public Health, Department of Medicine, UC San Diego , La Jolla, California 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