Cefoxitin Effective for Extended-Spectrum ß-Lactamase E coli Urinary Tract Infections

Cefoxitin was effective in patients with urinary tract infections caused by ESBL E coli, with resolution of fever and dysuria observed in all patients after therapy completion.

Cefoxitin is effective for the treatment of patients with urinary tract infection caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli, with an optimal dose of 2 g every 6 hours via extended intravenous (IV) infusion for those with normal creatinine clearance. These study results were presented at IDWeek 2022, held from October 19 to 23, 2022, in Washington, DC.

Researchers conducted a study to evaluate the use of cephamycins as a carbapenem sparing agent in the treatment of UTI caused by ESBL E coli. Eligible patients included hemodynamically-stable adults with negative blood cultures and symptoms suggestive of UTI. Patients initially received antibiotic therapy, and those with urine cultures that grew ESBL E coli were switched to 2 g of extended-infusion IV cefoxitin every 6 hours.

A total of 46 patients were included in the analysis, of whom the mean duration of antibiotic therapy prior to switching to cefoxitin was 2.6±1 days, and the mean duration of cefoxitin therapy was 4.5±2.2 days.

Following treatment, resolution of fever and dysuria was observed in all patients. There were 6 patients who required hospital readmission within 30 days, of whom none were readmitted due to UTI. Of 30 patients who underwent repeat urinalysis at 48 hours, results showed all had experienced reduced pyuria.

Analysis of repeat cultures obtained from 39 patients following treatment completion showed conversion to culture-negative status occurred among 36 patients.

“Further larger studies, involving patients with pyelonephritis, are needed to validate these findings,” the researchers concluded.

Disclosure: One author reported affiliations with the pharmaceutical industry. Please see the reference for a full list of disclosures.


Nathan RV, Tran D. Utility of cefoxitin for the treatment of ESBL-producing E. coli urinary tract infections. Presented at: IDWeek 2022; October 19-23; Washington, DC. Poster 680.