Retrospective Analysis of Ceftriaxone 1 Gram or 2 Grams for Bacteremia

Background: Ceftriaxone is a third-generation cephalosporin commonly used for treating bacteremia caused by gram-positive organisms such as Streptococcus spp. and gram-negative organisms such as Enterobacterales. The typical doses for treating bacteremia are either 1 gram or 2 grams daily. Despite its widespread use, there are limited data on the optimal treatment dose for bacteremia. Methods: This IRB-approved retrospective cohort study evaluated the difference in the clinical failure rate among patients who received 1 gram or 2 grams of ceftriaxone once daily for documented bacteremia. Clinical failure was defined as a composite of the following: antibiotic escalation, escalation to intensive care, and 30-day readmission due to an infectious cause. Adult patients admitted to Long Island Jewish (LIJ) Valley Stream, LIJ Forest Hills, or LIJ Medical Center in 2022 who received ceftriaxone were reviewed for inclusion. Patients were excluded if they received ceftriaxone for endocarditis or meningitis, had a positive blood culture with a ceftriaxone-resistant pathogen, or received ceftriaxone for less than 72 hours. Results: A total of 128 patients were included in this study. Approximately 46.9% of the participants received a 1 gram dose, while 53.2% received a 2 gram dose. 35.4% of patients in the 2 gram group experienced clinical failure compared to 21.7% in the 1 gram group (P = .08, OR 0.51; 95% CI 0.23-1.11). Conclusion: Our findings indicate that the primary outcome of clinical failure did not significantly differ between the 1 gram and 2 gram doses.