Is there a role for beta-lactams as step-down oral therapy for uncomplicated gram-negative bacteremia?

For carefully selected patients - yes. Patients who might be good candidates for transition to oral beta-lactams for uncomplicated gram-negative bacteremia would-be patients:

• clinically stable, improving on IV abx
• with functioning GI tracts (no issues with absorption of antibiotics)
• not immunocompromised
• good clinical follow-up available

In this cohort study, Tingsgård et al., PMID 38261322, you will notice that oral beta leactams were the step-down therapy of choice for the majority of the coho...

Agree with Dr. @Dr. First Last, most often for urosepsis, once source control is achieved.

Agree with Dr. @Dr. First Last. It has been our practice to do this for many years and, to the best of our knowledge, there has not been any obvious downside and we have spared people quinolones or TMP Sulfa in older patients on ARB/ACE-I. Some data would suggest higher relapse rates but I think that can be mitigated by using the right beta-lactam (oral cephalosporins with high bioavailability) in patients with no abscess or obstruction.

Here's some recent data:

Alzaidi et al., Open Forum Infect...

Agree with Dr. @Dr. First Last. I also will base in source of bacteremia, since majority are kidney (source control/stone/obstruction) before switch to oral.

How about for Renal stones causing pyelonephritis and Bacteremia, Urology performs stent placement? Oral ok?

I agree, when there is a urinary source. the data are better than they were in a way. Cephalexin has done "better" in this setting, assuming of course the GNR isolate is susceptible.

A problem I have noticed can be found in this question. GNR bacteremia is not like SAB or candidemia, yet, for years, we have been considering GNR bacteremia similarly. The source matters and, just as importantly, the bacterium matters. Many of us were taught that 2 weeks of Iv abx were needed for GNR bacteremia. Of...