Therapeutic Advances in Infectious Disease · Published 2025-12-01 · DOI 10.1177/20499361251401104
Background: Complicated urinary tract infections (cUTIs) cause significant morbidity and mortality. Multidrug-resistant (MDR) organisms complicate cUTI management, highlighting the need for effective antimicrobials. Objective: This scoping review was conducted to assess the role of plazomicin in managing cUTIs. Eligibility criteria: This review included observational studies, clinical trials, qualitative studies, and in vitro studies published between 01 January 2018 and 15 July 2025. Source of evidence: Searches were conducted on PubMed, MEDLINE, EMBASE, and Google Scholar. Method: The screening process involved reviewing titles and abstracts, followed by full-text evaluation. Results: Thirty studies were included in this review. Compared with meropenem, plazomicin demonstrated superior microbiological eradication at the test of cure (TOC; 89.5%), composite cure rate at the TOC (81.7%), and comparable clinical cure rates both at the TOC (89%) and end of intravenous therapy (96.3%). Adverse events, observed in 19.5% of patients, primarily included diarrhea, nausea, and renal dysfunction, indicating a favorable safety profile. In vitro data showed susceptibility rates for plazomicin ranging from 87% to 99.8% against Enterobacteriaceae, with superior activity over gentamicin, amikacin, and tobramycin. Plazomicin demonstrated synergistic effects with colistin, meropenem, and fosfomycin against extensively drug-resistant isolates and carbapenem-resistant Enterobacteriaceae. Conclusion: This review underscores plazomicin as a promising treatment for MDR cUTIs. However, limited data from low- and middle-income countries like India highlight the need for real-world studies on its efficacy, safety, and cost-effectiveness in such countries.
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