Category: Professional Posters
Purpose: The alarming rate of antibiotic resistance is one of the major threats to healthcare today. More specifically, resistant strains and reports of clinical failure with vancomycin, linezolid and daptomycin are increasing, indicating the need for an effective and safe alternative agent active against methicillin resistant Staphylococcus aureus (MRSA). Ceftaroline is fifth-generation cephalosporin, approved in 2010 for the treatment of skin & soft tissue infections (SSTIs) and community-acquired pneumonia (CAP). The objective of this study is to retrospectively evaluate elements of prescription and administration of ceftaroline use at a tertiary-care teaching hospital.
Methods: This is a retrospective observational study based in the American University of Beirut Medical Center, whereby a chart-review process was conducted from July 2017 through October 2018. Appropriateness of therapy was measured by appropriateness of indication, dosing, frequency, route of administration, duration, and the presence of ID approval (restricted prescription). Appropriateness of indication was defined according to medical policy, as use for severe infections (SSTI and CAP) where MRSA is suspected or confirmed, and for polymicrobial infections where the use of one drug is more convenient, safe, and cost-effective than a combination of antibiotics. It also included proper de-escalation after culture results, and atypical coverage in empiric treatment of CAP. As for dosing, doses were considered appropriate if properly adjusted to system creatinine clearance; failure to adjust dose at any time rendered dosing inappropriate. Moreover, appropriate dosing frequency was every 12 hours, and appropriate route of administration was the intravenous route. On the other hand, duration of therapy was considered appropriate if ceftaroline was given 5-7 days for CAP and 7-14 days for SSTI. Longer durations however, were also considered appropriate if extended therapy was clinically indicated. Lastly, restricted prescription was defined as the presence of an ID attending physician approval, with verbal approval for the initial dose.
Results: From July 2017 till October 2018, a total of 160 patients received ceftaroline, of which 151 were assessed. Ceftaroline was used for SSTIs in 42% of the cases, CAP in 42.5%, HAP in 9%, bone and joint infections in 2%, intra-abdominal infections (IAIs) in 2%, UTI in 2%, and primary bacteremia in 0.5%. Use was appropriate in 77% of the cases. 82% of the indications were community acquired, while 18% were hospital acquired. Also, a total of 90% of patients received ceftaroline empirically, while 10% received it as targeted therapy. On the other hand, dosing according to system CrCl was appropriate in 94% of patients, while that according to CrCl (Cockcroft & Gault) was 87% appropriate, meaning dosing according to system CrCl therefore overestimated values by around 7%. Moreover, duration of treatment was appropriate in 99.5% of patients. Also, dosing frequency and route were appropriate in all patients, since all patients received ceftaroline intravenously as every 12 hours. ID approval was also available in all patients with verbal approval upon initial dose, hence ceftaroline was given under ID restriction. Finally, no significant interactions were identified with ceftaroline, and adverse events were uncommon (3.3%).
Conclusion: Ceftaroline was given appropriately in the majority of cases, and was shown to be relatively safe, with no significant drug interactions. This agent may be recommended in relatively complicated SSTIs most likely caused by MRSA, non-MRSA CAP after first-line agents have failed (with atypical coverage in empiric used), and MRSA CAP. On that note, clinical pharmacists and antimicrobial stewardship committees may play an integral role in ensuring appropriate ceftaroline use through practioner education and real-time intervention.