Efficacy of Ceftriaxone 1 g daily Versus 2 g daily for The Treatment of Community-Acquired Pneumonia: A Systematic Review with Meta-Analysis

ABSTRACT

Introduction: Ceftriaxone has been recommended as a first-line treatment for various infections; however, the doses for pneumonia have not been a consensus in randomized clinical trials. To compare ceftriaxone 1 g daily efficacy to other ceftriaxone dosing regimens in community-acquired pneumonia.

Area covered: We performed a systematic review and meta-analysis on PubMed, Web of Science, Scopus, and LILACS. Randomized controlled trials of ceftriaxone in community-acquired pneumonia were included. Outcomes included clinical cure in modified intention-to-treatment, clinically and microbiologically evaluable patients.

Expert opinion: Ceftriaxone dosages of 1 g daily are as safe and effective as other antibiotic regimens for community-acquired pneumonia. Twenty-four articles fulfilled the inclusion criteria. Twelve studies evaluated ceftriaxone regimens at a dosage of 2 g daily and 12 studies evaluated ceftriaxone at a dosage of 1 g daily. The odds-ratio of clinical cure in the modified intention-to-treatment patients administered either ceftriaxone (4666 patients) or a comparator (4411 patients) was 0.98 (95% CI [0.82–1.17]). Comparator regimens showed similar efficacy to ceftriaxone regimens of 1 g daily, with an odds ratio of 1.03 (95% CI [0.88–1.20]). Dosages higher than ceftriaxone 1 g daily did not result in improved clinical outcomes for community-acquired pneumonia patients (OR 1.02, 95% CI [0.91–1.14]).

KEYWORDS:

• Ceftriaxone
• Streptococcus pneumoniae
• Antimicrobial stewardship
• community-acquired pneumonia
• dose

Article Highlights

• Pneumonia is one of the top infectious diseases related to death and correct management usually needs antimicrobial prescription. Unfortunately, there are few evidences of correct ceftriaxone dose regimens (1 g q24h, 1 g q12h or 2 g q24h).

• Antimicrobial resistance is rapidly increasing, and stewardship programs aim to encourage rational antibiotic usage. Therapeutic decision according ceftriaxone dosage may play an important role on decrease selective pressure.

• S. pneumoniae is the most isolated pathogen on pneumonia and in vitro or pk-pd studies demonstrate possibility of ceftriaxone 1 g q24h regimen since pneumococcal MIC is usually achieved with safety.

• None RCT compared different ceftriaxone regimens to each other. Thus, there is a lack in literature about ceftriaxone regimens and its clinical applicability.

• This systematic review and meta-analysis compared different ceftriaxone dosages with comparators and evaluated clinical and microbiologic cure rates (including analysis per pathogens).

Declaration of interest

F Tuon has received grants from Pfizer, AstraZeneca, and MSD in the last year and conducts research for National Council for Scientific and Technological Development (CNPQ). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.