Is there a role for cefpodoxime for treatment of acute cystitis caused by an Enterobacterales isolate with resistance to cefazolin, but susceptibility to ceftriaxone?

Yes – “sort of”.

This is a much more complex question than it initially seems. First some background.

CLSI has established a surrogate cefazolin breakpoint to predict susceptibility of urine isolates of Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis causing uncomplicated infection to 7 oral cephalosporins - cefaclor, cefdinir, cefpodoxime, cefprozil, cefuroxime, cephalexin, and loracarbef [1]. The current CLSI (M100-S33) MIC breakpoint for cefazolin surrogacy testing for uncomplicated urinary tract infections is ≤16 µg/mL for susceptible and ≥32 µg/mL for resistance. A cefazolin MIC of ≤16 µg/mL demonstrated ≥97.0% categorical agreement with each individually tested cephalosporin. Nonetheless, the 2013 CLSI meeting notes ind...