DOI: https://doi.org/10.36347/sasjm.2026.v12i04.014

Pages: 313-322

Extended-spectrum β-lactamase (ESBL)-producing Enterobacterales represent a growing therapeutic challenge in urinary tract infections (UTIs). While carbapenems have traditionally been the mainstay of treatment, several novel antibiotics have emerged as carbapenem-sparing alternatives. This review examines the role of newer β-lactam/β-lactamase inhibitor combinations and siderophore cephalosporins in managing ESBL-mediated UTIs, with emphasis on clinical efficacy, antimicrobial stewardship considerations, pharmacokinetic/pharmacodynamic properties, safety profiles, and appropriate patient selection. Additionally, the reemergence of older antibiotics including fosfomycin, aminoglycosides, and polymyxins is discussed in the context of contemporary antimicrobial resistance. Current evidence from both North American and European guidelines supports preferential reservation of newer agents for carbapenem-resistant infections, with traditional oral agents and carbapenems remaining first-line for most ESBL-mediated UTIs when susceptible.