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Complicated urinary tract infections (UTIs) caused by extended-spectrum β-lactamase (ESBL)–producing Enterobacterales are often treated with parenteral carbapenem therapy, which can promote resistance and be cumbersome to administer to outpatients. Oral noncarbapenem options would be ideal, and fosfomycin is often used off-label; however, robust evidence has been limited.
In an open-label trial at four South Korean hospitals, investigators randomized 300 inpatients with fosfomycin-susceptible infections who had improved after 3 to 7 days of IV antibiotics to either continue IV antibiotic therapy or switch to oral fosfomycin (3g daily). Urine cultures showed Escherichia coli in nearly 85% of each treatment group. The planned total trea…