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Outpatient parenteral antimicrobial therapy with ceftriaxone, a review
Christopher J A Duncan1, David A Barr, R Andrew Seaton
1Brownlee Centre for Infection, Tropical Medicine and Counselling, Gartnaval Hospital, Glasgow, G12 0YN, UK. chrisduncan@doctors.net.uk
Insights
Ceftriaxone remains a key antibiotic for outpatient parenteral antimicrobial therapy (OPAT). Its use in OPAT is safe and effective, with a low link to Clostridium difficile infection (CDI).
Area of Science:
- Infectious Diseases
- Antimicrobial Stewardship
- Clinical Pharmacology
Background:
- Ceftriaxone, a third-generation cephalosporin, is widely used in outpatient parenteral antimicrobial therapy (OPAT) despite hospital restrictions aimed at curbing antibiotic resistance and Clostridium difficile infection (CDI).
- The expansion of OPAT programs necessitates a re-evaluation of ceftriaxone's role in light of evolving antimicrobial prescribing practices.
Purpose of the Study:
- To assess the evidence base for ceftriaxone in OPAT.
- To review historical and current data on ceftriaxone indications and safety within the OPAT setting.
- To offer perspectives on the future utility of ceftriaxone in OPAT.
Main Methods:
- Systematic literature search of PubMed and Scopus, supplemented by hand-searching reference lists.
- Analysis of prospectively collected data from over 1,300 ceftriaxone-treated OPAT episodes over a decade in a UK center.
Main Results:
- Ceftriaxone demonstrates an excellent safety profile in the OPAT setting.
- Its broad-spectrum activity supports its use in diverse infections including skin, soft-tissue, bone, joint, and endocarditis.
- Unlike in inpatient settings, liberal ceftriaxone use in OPAT showed no strong association with CDI, suggesting other factors influence CDI risk.
Conclusions:
- Ceftriaxone is a safe and effective agent for a variety of infections treated with OPAT.
- The distinct relationship between ceftriaxone use and CDI in OPAT versus inpatient settings warrants further investigation into mediating factors.
- Ceftriaxone is likely to remain a valuable option for OPAT programs.
Background:
More than 30 years since it was developed for clinical use, the third-generation cephalosporin ceftriaxone remains the most commonly used agent for outpatient parental antimicrobial therapy (OPAT). Recent antimicrobial stewardship programmes have tended to restrict ceftriaxone use in hospitals to control antibiotic resistance and outbreaks of Clostridium difficle infection (CDI). Considering the expansion of OPAT programmes both in the UK and worldwide, revisiting the role of ceftriaxone in OPAT in the context of changing antimicrobial prescribing practices is timely.
Aim Of The Review:
To identify the evidence base for OPAT, review current and historical data on indications for, and safety of ceftriaxone within the OPAT setting, and to provide some perspectives on the future role of ceftriaxone.
Method:
We searched PubMed and Scopus for articles published in English, and hand searched reference lists. We also conducted a complementary descriptive analysis of prospectively acquired data on the use of ceftriaxone in more than 1,300 OPAT episodes over a 10-year period in our UK centre.
Results:
Ceftriaxone has an excellent safety profile in the OPAT setting, and its broad spectrum of activity makes it an established agent in a wide range of clinical infection syndromes, such as skin and soft-tissue infection, bone and joint infection, streptococcal endocarditis and several others. Intriguingly, in contrast to the inpatient setting, liberal use of ceftriaxone in OPAT has not been strongly linked to CDI, suggesting additional patient and environmental factors may be important in mediating CDI risk.
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