Therapeutic Strategies for Extended-Spectrum β-Lactamase-Producing Organisms: Carbapenem-Sparing and Oral Options.

Extended-spectrum β-lactamase (ESBL)-producing bacteria are increasingly common, especially in community settings of low-resource areas. While intravenous carbapenems are the most effective treatment, rising resistance highlights the importance of limiting their use. Alternative options, including certain penicillins, cephamycins, aminoglycosides, and fluoroquinolones, show promise and are being reconsidered due to availability and cost. Oral therapies like oral carbapenems and trimethoprim-sulfamethoxazole may enable earlier discharge and outpatient care. Newer β-lactams are in development but may be limited by high costs. Overall, combining intravenous and oral noncarbapenem agents with carbapenems used selectively can optimize ESBL infection management.