Comparative prospective cohort study of the efficacy and safety according to dose of Ceftriaxone in community-acquired pneumonia

There is limited prospective evidence of the efficacy and safety of ceftriaxone based on the difference in dosage of the drug as empiric therapy for community-acquired pneumonia (CAP). This study aimed to compare initial treatment failure, 30-day mortality and side effects between ceftriaxone doses of 1g twice a day (1g x2) and 2g once a day (2g x1) given intravenously to hospitalized adult CAP patients. We prospectively included patients with CAP who were admitted to our hospital between October 2010 and December 2018. We analyzed patients who were initially treated solely with 1g x2 or 2g x1 of ceftriaxone. The primary outcome was initial treatment failure, and secondary outcomes were 30-day mortality and side effects. Inverse probability of treatment weighting (IPTW) analysis was used to reduce biases. Among 457 CAP patients, there were 186 patients in the 1g x2 group and 271 patients in the 2g x1 group. There were no significant differences in initial treatment failure rate (2.69 % and 4.43 %, p=0.34) and 30-day mortality rate (3.28 and 6.45 %, p=0.17) between the former and latter groups. There was also no significant difference in side effects between the two groups, although there was a marginally significant difference (1.08 % and 4.43 %, p= 0.06). These significant differences and tendency to difference were almost similar to the results after IPTW analysis (p=0.27, 0.13 and 0.08). This study revealed that there are no significant differences between the effects of ceftriaxone administration at doses of 1g x2 and 2g x1 to adult CAP patients, in terms of initial treatment failure, 30-day mortality andoccurrence of side effects.