{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T16:46:17Z","timestamp":1792514777337,"version":"4.5.0"},"reference-count":16,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T00:00:00Z","timestamp":1774224000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ann Pharmacother"],"published-print":{"date-parts":[[2026,12]]},"abstract":"\n Background:<\/jats:title>\n Oral step-down therapy for the treatment of gram-negative blood stream infections (GNBSIs) has been shown to be noninferior to full courses of intravenous (IV) therapy. Studies comparing oral fluoroquinolones, sulfamethoxazole-trimethoprim (SMX-TMP), and beta-lactams have reported similar treatment outcomes, but beta-lactam groups have been small, and efficacy has been questioned given lower oral bioavailability.<\/jats:p>\n <\/jats:sec>\n \n Objective:<\/jats:title>\n This study aims to evaluate the safety and efficacy of oral cephalosporins compared with penicillins for step-down therapy for the treatment of GNBSI.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n This was a retrospective study in adult patients admitted for Enterobacterales GNBSI that were transitioned from IV antibiotics to an oral beta-lactam. The primary outcome was treatment failure. Secondary outcomes included components of the primary outcome, microbiological failure, antibiotic-associated adverse drug events (ADEs), and\n Clostridioides difficile<\/jats:italic>\n infection (CDI).\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Overall, 280 patients with GNBSI with step-down to an oral penicillin (\n n<\/jats:italic>\n = 140) or cephalosporin (\n n<\/jats:italic>\n = 140) were included. More patients in the cephalosporin group had a urinary source of infection (87.9% vs 62.1%,\n P<\/jats:italic>\n < 0.001) and urinary abnormalities (40% vs 28.6%,\n P<\/jats:italic>\n = 0.044). Treatment failure with oral cephalosporins was noninferior to penicillins (7.1% vs 7.1%; 95% confidence interval [\u20136.4, 6.4],\n P<\/jats:italic>\n = 0.002). No significant differences were found for microbiological failure, antibiotic-associated ADEs, or CDI.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion and Relevance:<\/jats:title>\n Oral cephalosporins were noninferior to oral penicillins as step-down therapy for Enterobacterales GNBSI. This represents the first comparison of oral beta-lactams for the treatment of GNBSI.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/10600280261426346","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T07:04:02Z","timestamp":1774249442000},"page":"1174-1181","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparison of Oral Cephalosporin and Penicillin Step-Down Therapy for the Treatment of Gram-Negative Blood Stream Infections: A Retrospective Observational Study"],"prefix":"10.1177","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3898-9840","authenticated-orcid":false,"given":"Bethany","family":"Volkmar","sequence":"first","affiliation":[{"name":"Department of Pharmacy, WakeMed Health and Hospitals, Raleigh, NC, USA"},{"name":"Department of Pharmacy, ECU Health Medical Center, Greenville, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin C.","family":"Akerman","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, WakeMed Health and Hospitals, Raleigh, NC, USA"},{"name":"University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9579-5775","authenticated-orcid":false,"given":"Alison I.","family":"Orvin","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, WakeMed Health and Hospitals, Raleigh, NC, USA"},{"name":"University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,23]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2018.6226"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2016.07.013"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgar.2019.07.026"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.20166"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2017.12.007"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1017\/ash.2023.435"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofae193"},{"key":"e_1_3_4_9_2","author":"Clinical and Laboratory Standards Institute (CLSI)","year":"2023","unstructured":"Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing, 33rd Informational Supplement (CLSI Document M100-S25). CLSI; 2023.","journal-title":"Performance Standards for Antimicrobial Susceptibility Testing, 33rd Informational Supplement"},{"key":"e_1_3_4_10_2","unstructured":"Non-Inferiority Clinical Trials to Establish Effectiveness. Guidance for Industry. FDA; 2016. 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