ArticleOpen forum infectious diseases2019
Oral Fluoroquinolone or Trimethoprim-sulfamethoxazole vs. ß-lactams as Step-Down Therapy for Enterobacteriaceae Bacteremia: Systematic Review and Meta-analysis.
Article in Open forum infectious diseases, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers.
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Who cites it
42 citing papers in PubMed, 74 citations in OpenAlex.
- The Use of Step-Down Oral Antibiotic Therapy for Uncomplicated Gram-Negative Bacteremia and Risk Factors for Adverse Outcomes.Open forum infectious diseases · 2026Trial
- Navigating the Muddled Middle: A Case-Based Exploration of Oral β-Lactams for Systemic Gram-Negative Infections.Open forum infectious diseases · 2025Trial
- Real-World Effectiveness of Intravenous and Oral Antibiotic Stepdown Strategies for Gram-Negative Complicated Urinary Tract Infection With Bacteremia.Open forum infectious diseases · 2024Trial
- Oral β-Lactams, Fluoroquinolones, or Trimethoprim-Sulfamethoxazole for Definitive Treatment of UncomplicatedOpen forum infectious diseases · 2024Trial
- Review
- Management of Gram-Negative Bloodstream Infections With Oral Antibiotics in Solid Organ Transplant Recipients.Clinical transplantation · 2026Observational
- Clinical outcomes with oral cephalosporins as definitive treatment of Enterobacterales bacteremia from a urinary source based on cefazolin minimum inhibitory concentration.Antimicrobial agents and chemotherapy · 2026Article
- Effect of oral beta-lactam dosing on outcomes of bacteremic Gram-negative urinary tract infections: a real-world analysis.Microbiology spectrum · 2026Article
- Interventions to optimize duration of antibiotic therapy and encourage oral transition for uncomplicated gram-negative blood stream infections across a health system.Infection control and hospital epidemiology · 2026Article
- Gut check: antimicrobial stewardship opportunities in intra-abdominal infections.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Review
- Efficacy of a transition to oral antimicrobial therapy for gram-negative bacilli bloodstream infection: systematic review and meta-analysis.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Article
- Assessing the feasibility of a platform trial for Gram negative bloodstream infections: results from the vanguard phase of BALANCE.BMJ open · 2025Article
- Co-resistance between oral antibiotics for pyelonephritis and those for cystitis-applying an escalation antibiogram model to local community data.JAC-antimicrobial resistance · 2025Article
- Gram-negative bloodstream infections: where can we do better? A retrospective cohort study.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2025Observational
- Very Early Transition to Oral Antibiotics in Uncomplicated Enterobacterales Bloodstream Infections: Effectiveness and Impact on Carbon Footprint Saving.Antibiotics (Basel, Switzerland) · 2025Article
- Antibiotic Therapy Duration for Multidrug-Resistant Gram-Negative Bacterial Infections: An Evidence-Based Review.International journal of molecular sciences · 2025Review
- Clinical Outcomes ofAntibiotics (Basel, Switzerland) · 2025Article
- Common Bacterial Infections in Persons Who Inject Drugs.Medicines (Basel, Switzerland) · 2025Review
- Oral switch antibiotic therapy in uncomplicatedJAC-antimicrobial resistance · 2025Article
- Standardization in the management of gram-negative bloodstream infections after implementation of a clinical care guideline at a large academic, safety-net institution: a quasi-experimental study.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundUsing published data, we sought to compare outcomes in patients transitioned to either oral fluoroquinolones (FQ) or trimethoprim-sulfamethoxazole (TMP-SMX) versus ß-lactams (BL's) after an initial intravenous (IV) course for gram-negative rod (GNR) bacteremia.
methodsWe conducted a systematic review of PubMed and EMBASE and published IDWeek abstracts. We included studies that reported all-cause mortality and/or infection recurrence in patients transitioned to oral FQ/TMP-SMX and BL's.
resultsEight retrospective studies met inclusion criteria with data for 2,289 patients, of whom 65% were transitioned to oral FQ, 7.7% to TMP-SMX, and 27.2% to BL's. Follow up periods ranged from 21 to 90 days. All-cause mortality was not significantly different between patients transitioned to either FQ/TMP-SMX or BL's (OR 1.13; 95%CI, 0.69-1.87). Overall recurrence of infection, either bacteremia or the primary site, occurred more frequently in patients transitioned to oral BL's vs. FQ's (OR 2.05, 95% CI 1.17 to 3.61). Analysis limited to recurrent bacteremia was similarly suggestive although limited by small numbers (OR 2.32, 95% CI 0.99 to 5.44). However, based on known pharmacokinetics/pharmacodynamics, prescribed ß-lactam dosing regimens were frequently suboptimal.
conclusionsIn the step-down IV to oral treatment of GNR bacteremia, we found insufficient data regarding outcomes after oral TMP-SMX; however, selection of a FQ over commonly utilized ß-lactam regimens may reduce chances of infection recurrence. While this may be a class effect, it may simply be the result of inadequate dosing of ß-lactams. Additional investigations are warranted to determine outcomes with TMP-SMX and optimized oral ß-lactam dosing regimens.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.