The Role of Sulopenem in the Treatment of Uncomplicated Urinary Tract Infections: A Systematic Review and Meta-Analysis.

Uncomplicated urinary tract infections (uUTIs) rank as one of the most frequent bacterial infections, particularly in females, and antimicrobial resistance is complicating the situation more and more. So, first-line agents such as nitrofurantoin and trimethoprim-sulfamethoxazole are losing their beneficial effects. There is an urgent call for new therapies due to the very alarming global rise of extended-spectrum β-lactamase-producing bacterial isolates. Sulopenem is a new antibiotic of the penem series available for both intravenous and oral administration, a potential candidate against multidrug-resistant Gram-negative organisms. It offers anti-β-lactamase stability, oral activity, and possible hospitalization duration reduction, hence, making it the best option for consideration. This article conducts a review of the evidence surrounding sulopenem regarding efficacy, safety, and resistance mechanisms. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, clinical trials were searched in databases, including PubMed, Scopus, Embase, Medline, and the Cochrane Library. Five studies were selected that include randomized trials, comparative effectiveness research, and pharmacokinetic/pharmacodynamic (PK/PD) modeling studies. Main outcomes were microbiological cure, resolution of symptoms, recurrence of clinical symptoms, and adverse events.  Sulopenem was either non-inferior or superior to comparators in important subgroups. Ciprofloxacin-resistant infections showed better test-of-cure results with sulopenem, 62.6% versus 35.0%. Sulopenem/probenecid was equal or superior to amoxicillin/clavulanate, including among resistant strains. PK/PD modeling confirmed bactericidal concentrations for a sustained duration.