Ceftriaxone Guided IV to PO

is admitted with pyelonephritis. Blood and urine cultures grow E. coli with the below susceptibilities. They have a QTc of 502 ms and a sulfa allergy.

Amox – R
Amox-clav – R
Cefazolin – R
Ceftriaxone – S
Ciprofloxacin – S
TMP-SMX – S

Which of the following is best to send the patient home on?

A. Ciprofloxacin PO
B. TMP-SMX PO
C. Cefpodoxime PO
D. Ceftriaxone IV

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Best Answer

Cefpodoxime PO

Explanation: Ciprofloxacin and TMP-SMX are not optimal due to a prolonged QTc and sulfa allergy. Ceftriaxone susceptibility does not guarantee susceptibility to oral 2nd and 3rd generation cephalosporins, but high agreement (> 90%) has been seen with E. coli, K. pneumoniae, K. oxytoca and P. mirabilis isolates. The 2025 IDSA Complicated Urinary Tract Infections (cUTI) guidelines suggest transitioning from intravenous to oral antibiotics in patients with cUTI (including pyelonephritis) with Gram-negative bacteremia and identify cefpodoxime as an option.