Ceftriaxone Compared with Cefotaxime for Serious Bacterial Infections

Abstract

Ceftriaxone was compared with cefotaxime for the treatment of serious bacterial infections in a prospective, randomized, double-blind clinical trial. The dose of ceftriaxone was 2 g once a day, and the dose of cefotaxime was 2 g every 4 h. Metronidazole was added if anaerobic infection was suspected. Explicit criteria were used to define infections, clinical response, and adverse effects. Ceftriaxone was given to 88 patients and cefotaxime to 83. The two treatment groups did not differ in types of infection, infecting organisms, and severity of underlying disease. The response rate was 81% (71/88) for ceftriaxone and 80% (66/83) for cefotaxime. The power of the study to detect a 15% difference in response rate at P less than .1 was 90%. The frequency of diarrhea, thrombophlebitis, prothrombin time, prolongation, colonization, and superinfection did not differ between treatment groups. Ceftriaxone 2 g once a day was as safe and effective as cefotaxime 2 g every 4 h for suspected serious bacterial infections.

Antimicrobial Therapy for the Elderly Patient

“…Of the many third‐generation cephalosporins, cefoperazone and ceftriaxone offer the advantage of infrequent dosing schedules (Table 2). Ceftriaxone has been studied recently in middle‐aged to older adults with a variety of infections (lungs, urinary tract, skin and soft tissue, bone and joint, bacteremia) 133 , 134 . With a daily single‐dose of 2 g, ceftriaxone was effective and safe.…”

Antimicrobial Activity of Ceftriaxone Compared with Cefotaxime in the Presence of Serum Albumin

“…The clini cal sig nifi cance of the nega tive ef fect of cef tri axone bind ing to se rum al bu min re mains con tro ver sial. While the phar ma coki netic and thera peu tic ef fi cacy data from the four clini cal stud ies of cef tri ax one and ce fo taxime (5,(29)(30)(31) are equivo cal in show ing a dif fer ence be tween the two agents, Man dell et al (31) and Smith et al (32) re ported that the thera peu tic ef fi cacy of cef tri ax one (2 g every 24 h) was com pa ra ble with that of ce fo taxime (2 g every 6 h) in treat ing se ri ous no so comial bac te rial in fec tions.…”

Adverse Effects of Newer Cephalosporins

“…Gastrointestinal adverse effects of orally administered cephalosporins as discussed below include those shared with other antibiotic classes: nausea, vomiting and diarrhoea. Intravenous administration of cephalosporins has been associated with a low but consistent incidence of thrombophlebitis in I to 2% of patients (Fernandez-Guerrero et al 1991;Meyers 1985;Smith et al 1989). Intramuscular administration may be associated with significant pain; cefalothin, for example, is contraindicated by this route.…”

“…In contrast, only 5% of cefotaxime and ceftizoxime are excreted into bile. As a result, a higher incidence of diarrhoea (10 to 40%) [Eron et al 1983;Harrison et al 1983;Nahata & Miller 1989;Smith et al 1989) has been reported with ceftriaxone than with cefotaxime (1.2%) [Smith 1981), presumably because of increased intraintestinal concentrations and altered faecal flora.…”