Recommendation for treatment of severe infections caused by Enterobacteriaceae producing extended-spectrum β-lactamases (ESBLs)


  • D. L. Paterson

    1. Infectious Disease Section, Instituto per I Trapianti Terapie as Alta Specializzazione, Palermo, Italy and Infectious Disease Division, University of Pittsburgh Medical Center, Pittsburgh, USA
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Corresponding author and reprint requests: D. L. Paterson, Infectious Disease Section, Istituto per I Trapianti e Terapie ad Alta Specializzazione, Piazza Sett'Angeli, 10, 90134 Palermo, Italy Tel: +39 335 564 1485 Fax: +39 091 666 8148 E-mail:


Extended-spectrum β-lactamase (ESBL)-producing organisms are a global problem. No randomized controlled trials have ever been performed to guide optimal treatment. However, in vitro studies and observational studies strongly suggest that carbapenems (imipenem or meropenem) should be regarded as drugs of choice for serious infections due to ESBL-producing organisms. Other β-lactam antibiotics (cefepime, β-lactam/β-lactamase inhibitor combinations) are not suitable as first-line therapy. The increasing frequency of the association between quinolone resistance and ESBL production have greatly limited the role of this class of antibiotic against ESBL producers.