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Differences between ceftriaxone and cefotaxime: microbiological inconsistencies.

John G Gums¹, D Wesston Boatwright, Mark Camblin

¹Department of Pharmacy Practice, University of Florida, Gainesville, FL 32601, USA. jgums@ufl.edu

The Annals of Pharmacotherapy

|December 21, 2007

Summary

Increasing penicillin-resistant Streptococcus pneumoniae (PRSP) isolates show differing susceptibility to cefotaxime and ceftriaxone. Hospital labs must monitor these changes for appropriate antibiotic selection in pneumococcal infections.

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Area of Science:

Microbiology
Infectious Diseases
Pharmacology

Background:

Cefotaxime and ceftriaxone are historically considered to have similar in vitro activity against Streptococcus pneumoniae.
Emerging resistance patterns necessitate a review of antimicrobial susceptibility data.

Purpose of the Study:

To investigate the reasons for increasing cefotaxime resistance in pneumococcal isolates.
To determine the clinical implications of observed differences in susceptibility between cefotaxime and ceftriaxone.

Main Methods:

Literature review of MEDLINE (1966-2007) using relevant MeSH terms.
Evaluation of abstracts, surveillance databases, and unpublished data from health departments.
Analysis of minimum inhibitory concentration (MIC) and pulsed-field gel electrophoresis studies.

Main Results:

Experimental models predicted less variation in ceftriaxone MIC compared to cefotaxime.
Ceftriaxone maintains concentrations above the S. pneumoniae MIC for longer dosing intervals.
Discrepancies in susceptibility were observed, with isolates being more susceptible to ceftriaxone than cefotaxime, particularly in areas with high rates of penicillin-resistant S. pneumoniae (PRSP).

Conclusions:

Increased PRSP rates correlate with differing pneumococcal susceptibility to ceftriaxone and cefotaxime.
Hospital laboratories need to detect these evolving resistance trends.
Clinicians should carefully select antibiotics for S. pneumoniae infections based on current susceptibility data.