Navigating the Muddled Middle: A Case-Based Exploration of Oral β-Lactams for Systemic Gram-Negative Infections

Oral β-lactams are frequently referred to as low bioavailability agents that are inferior in the treatment of systemic gram-negative infections. This notion limits their utility beyond their use. The pharmacokinetic/pharmacodynamic profiles of oral β-lactams differ among agents, and each agent must be considered individually in the context of the patient. In this review, we describe 3 scenarios where oral β-lactams may play a role in the treatment of systemic gram-negative infections and the decision process to select or avoid these agents. Each case represents a risk-vs-benefit scenario in which the degree of confidence in using an oral β-lactam varies.