In this episode, I’ll discuss cefazolin for methicillin-susceptible staphylococcus aureus bacteremia.
Until recently, the strongest data on what to use to treat MSSA bacteremia has always been for the penicillinase-resistant penicillins like nafcillin and cloxacillin. But these antibiotics have high rates of adverse events. Cefazolin has a much more favorable safety profile and is preferred by many clinicians for this reason; however, data suggesting it is equivalent to the penicillinase-resistant penicillins for MSSA bacteremia used to be only retrospective in nature.
Back in Episode 1074 I discussed a randomized clinical trial over more than 300 patients published in the Lancet showing cefazolin is non-inferior to cloxacillin. And now in the New England Journal of Medicine a group of authors has published a randomized trial of over 1200 patients looking at the same topic.
The NEJM study was an open-label, randomized comparison of cefazolin with an antistaphylococcal penicillin (flucloxacillin or cloxacillin) in adult patients with penicillin-resistant, methicillin-susceptible S. aureus bacteremia. The primary outcome was death from any cause within 90 days after enrollment in the platform. Secondary safety outcomes included the development of acute kidney injury within 14 days.
Mortality was 15% in the cefazolin group and 17% in the antistaph group, a difference that was associated with a 99.2% probability of noninferiority and 89.8% probability of superiority.
Acute kidney injury occurred in 13.9% of patients in the cefazolin group and 19.6% in the antistaph group for an adjusted odds ratio of 0.67, statistically favoring cefazolin for safety.
The authors concluded:
In patients with methicillin-susceptible S. aureus bacteremia, cefazolin was noninferior to flucloxacillin or cloxacillin with respect to 90-day mortality and was associated with a lower incidence of acute kidney injury.
This adds to a now significant body of evidence that cefazolin is at least as effective as antistaph penicillins for MSSA bacteremia and much less likely to cause acute kidney injury.
The article in this episode is a selection from my Hospital Pharmacy Academy’s weekly literature digest. Have you ever felt like your physician colleagues are one step ahead of you with new literature developments? Every week, Academy members are provided a summary curated and explained by me of the top hospital pharmacy-related articles published that week from over 20 major journals and sources to save you time and keep you up to date with the literature. To get immediate access, go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
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