INTRODUCTION: remaining around 5%. AREAS COVERED: A literature search was performed via PubMed during January-February 2026. The review centers on a brief mention of the mechanism of action, resistance mechanisms, pharmacokinetics, pharmacokinetic/pharmacodynamics, adverse effects, and clinical use. Pivmecillinam is stable against many broad-spectrum beta-lactamases increasing its versatility as empiric antibiotic. The main indication is uUTI, but it is also used for treatment of acute pyelonephritis. The review goes into detail about the clinical experience viz. dose and duration of treatment with suggestions for dosing recommendations. There remains some debate on the ideal dose and duration of treatment. Pivmecillinam can also be used for treatment of some bacterial diarrhea types. EXPERT OPINION: Pivmecillinam can play an important role as empiric and directed treatment for UTIs due to its beneficial antibacterial spectrum against common uropathogens, stability toward beta-lactamases, minor effect on microbiomes and general safety.
Frimodt-Möller et al. (Thu,) studied this question.