There is a growing body of evidence supporting early transition to oral antibiotic therapy to complete treatment courses for gram-negative bloodstream infections (GN-BSI) (1–3). Most available data focus on oral fluoroquinolones and trimethoprim/sulfamethoxazole (TMP/SMX) due to their high oral bioavailability (4–6). Although antimicrobial susceptibility testing (AST) results for these agents are generally available to clinicians, toxicities associated with fluoroquinolones (e.g., Clostridioides difficile infections, tendonitis, mental status changes, and prolonged QT intervals) and TMP/SMX (e.g., hyperkalemia, hypersensitivity syndromes, and cytopenias), and increasing resistance tempers enthusiasm for these agents (7). Oral beta-lactams are generally well-tolerated but underutilized for a variety of reasons, including lack of AST result availability, wide ranges in oral bioavailability across agents, unclear dosing regimens to optimize pharmacokinetic/pharmacodynamic (PK/PD) efficacy targets, and limited clinical effectiveness data for the treatment of GN-BSI (8).

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