Outcomes of Cefazolin versus Ceftriaxone Therapy in Treating Lower Respiratory Tract Infections in Adults

Abstract

OBJECTIVE:

To determine whether choice of a first- versus third-generation cephalosporin as initial therapy for lower respiratory tract infections in hospitalized adults affects the course and duration of care, both of which may influence antimicrobial treatment cost.

DESIGN:

Retrospective analysis of discharge abstracts and hospital pharmacy records.

SETTING:

Forty-eight US acute-care hospitals.

PATIENTS:

One thousand ninety-two hospitalized adults (aged >17 y) with principal diagnoses of lower respiratory tract infections (DRGs 79–80, 89–90).

INTERVENTIONS:

Cefazolin or ceftriaxone, given as sole antimicrobial therapy for at least one day.

MAIN OUTCOME MEASURES:

(1) The number of patients who received another parenteral antibiotic anytime prior to hospital discharge; (2) the number of days during which patients received any parenteral antibiotic while in the hospital; and (3) the number of days patients remained hospitalized following the start of antibiotic therapy.

RESULTS:

Patients treated with cefazolin (n=763) were more likely to receive another parenteral antibiotic while in the hospital (30.3 vs. 20.7 percent; p<0.001) and received more total days of therapy (7.2 vs. 6.7 d; p<0.05) than those treated with ceftriaxone (n=329). Although the time to hospital discharge did not differ in the full sample (9.2 d for both groups), it was greater among those receiving cefazolin (8.6 vs. 8.0 d; p<0.05) when patients with lengths of stay exceeding 24 days were excluded from both groups.

CONCLUSIONS:

In addition to acquisition cost, differences in course and duration of care should be considered when determining the most cost-effective choice for antimicrobial therapy.