Ceftriaxone 1 vs 2 g: Which dose leads to fewer clinical failure in bacteremia?

The incidence of clinical failure does not differ between 1- and 2-g doses of ceftriaxone for the treatment of bacteremia, results of a study have shown.

In total, 128 patients were enrolled in this study. Of these, 46.9 percent received 1 g of ceftriaxone, while 53.2 percent received a 2-g dose. Clinical failure occurred in 35.4 percent of patients in the 2-g dose group and in 21.7 percent of those in the 1-g dose group (odds ratio, 0.51, 95 percent confidence interval, 0.23‒1.11; p=0.08).

“Our findings indicate that the primary outcome of clinical failure did not significantly differ between the 1- and 2-g doses,” the investigators said.

This cohort study assessed the difference in the clinical failure rate among patients receiving 1 or 2 g of ceftriaxone once daily for bacteremia. Clinical failure referred to a composite of antibiotic escalation, escalation to intensive care, and 30-day readmission to an infectious cause.

The investigators screened adult patients admitted to Long Island Jewish (LIJ) Valley Stream, LIJ Forest Hills, or LIJ Medical Center in 2022 who received ceftriaxone for inclusion. They excluded those that received ceftriaxone for endocarditis or meningitis, had a positive blood culture with a ceftriaxone-resistant pathogen, or received ceftriaxone for <72 h.

“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 investigators said.

“The typical doses for treating bacteremia are either 1 or 2 g daily,” they added.