Comparative prospective cohort study of efficacy and safety according to dosage and administration of ceftriaxone for community-acquired pneumonia

Introduction: Limited prospective evidence has been accumulated regarding the efficacy and safety of ceftriaxone (CTRX) based on differences in dosage and administration of the drug as empiric therapy for community- acquired pneumonia (CAP). This study aimed to compare initial treatment failure, 30-day mortality, and side effects between two groups of hospitalized adult CAP patients: one receiving intravenous CTRX at 1g twice daily (1gq12hr) and the other receiving 2g once daily (2gq24hr). Methods: We prospectively included patients with CAP admitted to our hospital between October 2010 and December 2018. We analyzed patients initially treated solely with CTRX as either 1gq12hr or 2gq24hr. The primary outcome was initial treatment failure, while secondary outcomes were 30-day mortality and side effects. Inverse probability of treatment weighting (IPTW) analysis was used to minimize biases. Results: Among the 457 CAP patients, 186 patients were in the 1gq12hr group and 271 patients were in the 2gq24hr group. After IPTW analysis, no significant differences in initial treatment failure rate (2.43 % vs 4.46 %, p = 0.27) or 30-day mortality rate (2.95 % vs 6.43 %, p = 0.13) were seen between groups. A small but noteworthy tendency was noted in the frequency of side effects between the two groups (1.04 % vs 4.20 %, p = 0.08) following IPTW analysis, even though the difference was not significant. Conclusions: This study did not find any significant difference between ceftriaxone 1gq12hr and 2gq24hr regarding efficacy or safety in adult patients with CAP. However, CTRX 1gq12hr may represent a safer option in terms of side effects.