ReviewInfection2026
Oral tebipenem pivoxil for complicated urinary tract infections: evidence, potential role in IV-to-oral transition, and antimicrobial stewardship.
Review in Infection, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
0 citing papers in PubMed.
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Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeComplicated urinary tract infections (cUTIs), including pyelonephritis, are increasingly challenging when resistant Enterobacterales eliminate conventional oral treatment options. Tebipenem pivoxil (UTEBZI), approved by the US Food and Drug Administration in June 2026, is the first oral carbapenem approved in the United States for selected adults with cUTI. This review evaluates its pharmacology, microbiological activity, efficacy, safety, and potential role in intravenous (IV)-to-oral treatment and antimicrobial stewardship
methodsA structured narrative review of PubMed/MEDLINE, regulatory documents, clinical-trial reports, guidelines, pharmacokinetic/pharmacodynamic studies, microbiological studies, and relevant oral step-down literature was conducted through 12 August 2026. Priority was given to randomized phase 3 trials, FDA prescribing information, and IDSA guidance
resultsADAPT-PO and PIVOT-PO demonstrated noninferiority of complete oral tebipenem regimens to IV ertapenem and IV imipenem-cilastatin, respectively, with high clinical cure rates. Tebipenem retains activity against many ESBL- and AmpC-producing Enterobacterales but lacks reliable activity against major carbapenemases. Neither phase 3 trial randomized clinically improving patients after initial IV therapy; therefore, direct randomized evidence for a formal tebipenem step-down strategy is lacking. Important uncertainties include limited bacteremia data, every-six-hour adherence, optimal post-IV duration, cost-effectiveness, microbiome effects, and resistance selection
conclusionTebipenem is an important culture-directed oral option for selected adults with cUTI when narrower effective oral agents are unavailable. Its most defensible early role is replacement of otherwise necessary continued IV carbapenem therapy in carefully selected patients, with source control, susceptibility confirmation, renal doseadjustment, safety screening, duration planning, and stewardship oversight. Dedicated switch, bacteremia, implementation, and resistance-surveillance studies remain needed.
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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.