Gepotidacin in oral antibacterial pharmacotherapy: efficacy, safety, and clinical positioning

Rising antimicrobial resistance and limited innovation in oral antibacterial therapy continue to complicate treatment of common outpatient infections. Gepotidacin (Blujepa) is an oral triazaacenaphthylene antibacterial that inhibits bacterial type II topoisomerases. In the United States, it is approved for uncomplicated urinary tract infection (uUTI) in eligible female adults and adolescents, and for uncomplicated urogenital gonorrhea in eligible patients with limited or no alternative treatment options.

This narrative review evaluates gepotidacin's mechanism, clinical pharmacology, efficacy, safety, and therapeutic positioning. Literature published through 30 June 2026 was identified through PubMed, Scopus, and SciFinder-n, supplemented by targeted searches of U.S. Food and Drug Administration (FDA), World Health Organization (WHO), and Centers for Disease Control and Prevention (CDC) sources. Efficacy is assessed primarily from the EAGLE-2, EAGLE-3, and EAGLE-1 phase 3 trials, while regulatory and surveillance evidence informs approved use, safety, resistance, and clinical positioning.

Gepotidacin should be viewed as a selective addition to oral antibacterial pharmacotherapy rather than a replacement for established first-line regimens. Its long-term role will depend on stewardship-aligned use, resistance surveillance, comparative-effectiveness data, and careful safety management.