Ceftriaxone, an Empirical Goldmine: A Systematic Review of Randomized Controlled Trials

Empiric therapy for community and health-care associated bacterial infections with high mortality is challenging with the continued development of resistant strains and the threat of multi-drug–resistant organisms. Pharmacists may impact patients’ outcomes by appropriately selecting initial antibiotic treatment, screening for duplication of therapy, and identifying the duration of therapy, regardless of whether a facility holds an antimicrobial stewardship program in place. The choice of ceftriaxone as an empiric therapy has been under-represented in many  ways and its choice as first-line antibiotic in fatal infections remain controversial. To investigate the current state of ceftriaxone, alone or as a part of step-down therapy, therapy in terms of clinical and bacteriological efficacy, as well as evaluate the economic burden intravenous ceftriaxone therapy poses in patients with six infections associated with severe mortality and morbidity worldwide and assess the reliability of ceftriaxone as an empirical therapy in these six infections since the increased threat of multi-drug resistant organisms. This systematic review with meta-analysis of randomized controlled trials involves the assessment of the clinical and microbiological efficacy of ceftriaxone compared with that of other antibiotics in community-acquired pneumonia, bacterial meningitis, acute pyelonephritis, gonorrhoea, complicated intra-abdominal infections and efficacy in the perioperative prophylaxis of local and systemic infections published in the dates between 1990 to 2019 was performed. The electronic databases of PubMed, the Cochrane Central Register of Controlled Trials and Google Scholar were reviewed to search for relevant randomized controlled trials. Additional references, review papers, and proceedings of seminars were also searched. We conducted a systematic review and meta-analysis of ceftriaxone for treatment of uncomplicated gonorrhoea compared with four other antibiotics. Thirteen randomized controlled trials (RCTs) totalling treatment of 2557 patients with uncomplicated gonorrhoea were included. Statistically significant differences were observed in side-effects, which were increased after ceftriaxone 250 mg versus cefotaxime 500 mg (odds ratio [OR] 1.87; 95% confidence interval [CI] 1.14-3.08). Cure rates of ceftriaxone 250 mg were significantly better than cefixime 400 mg (OR 1.77; 95% CI 1.11-2.80) as was ceftriaxone 125 mg versus spectinomycin 2 g (OR 3.44; 95% CI 1.08-10.90). There was no statistically significant difference between ceftriaxone 250 mg and cefixime 800 mg in cure rates (OR 1.39; 95% CI 0.92-2.10) or adverse effects (OR 1.29, 95% CI 0.58-2.84) for treating