Inducing ceftriaxone-deficiency in hospitals: practical stewardship insights

AIMED - Let's talk about antibiotics

2018 update! Just as relevant.

Upside – Ceftriaxone and cefotaxime (third generation cephalosporins-TGC) are amongst the most important agents for directed therapy of infections due to Gram negative organisms that are resistant to ampicillin or cephazolin (a first generation cephalosporin),  including Klebsiella pneumoniae .  They penetrate the CSF well, making them important agents for treatment of  meningitis due to Streptococcus pneumoniae and other susceptible pathogens.

Downside – third generation cephalosporins are  amongst the most misused and overused agents and as a result have strongly promoted the emergence and selection of resistant pathogens such as MRSA, VRE , extended-spectrum betalactamase (ESBL) producing coliforms, Enterobacter and related species (ampC cephalosporinase producers) and Clostridium difficile infection.

The bottom line- 

  • Hunter New England target is to maintain usage of third generation cephalosporins below 20 defined-daily doses per 1,000 patient-days
  • Implement guidelines that remove third generation cephalosporins from most empiric indications- see Australian Therapeutic Guidelines: Antibiotic for alternative choices…

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