Ceftriaxone Sodium

Bloodstream infections (BSIs) by methicillin-susceptible Staphylococcus aureus (MSSA) are a significant cause of morbidity and mortality, traditionally treated with antistaphylococcal penicillins (ASPs) or cefazolin. Ceftriaxone has emerged as an alternative due to its once-daily dosing regimen and favourable safety profile; however, its efficacy compared to the standard of care (SoC) remains controversial. This evidence synthesis aimed to assess the role of ceftriaxone in treating MSSA-BSIs.

A systematic literature search was conducted in PubMed, Embase, and Scopus up to December 31, 2025 (PROSPERO protocol CRD42024595748). Studies comparing ceftriaxone to ASPs or cefazolin for MSSA-BSIs were included. Primary outcomes were 30-day and 90-day all-cause mortality . Pooled effect sizes with their 95% confidence intervals (CIs), were calculated using random-effects models, odds ratios (ORs) and mean differences (MDs) according to the type of outcome.

Eleven studies totalling 2,568 patients were included. Ceftriaxone was associated with significantly increased 30-day mortality (OR 3.33; 95% CI: 2.17-5.10), although differences at 90 days were not significant (OR 1.71; 95% CI: 0.75-3.90). No significant differences were noted for clinical success (OR 0.49; 95% CI: 0.19-1.26), microbiological clearance (OR 1.66; 95% CI: 0.73-3.82). Adverse event rates were similar between groups.

Given the availability of various alternatives and the consistent short-term mortality signal observed, routine use of ceftriaxone for MSSA-BSIs, especially as initial therapy, is not supported by current evidence. Only novel findings from randomized studies may change the place in therapy of the drug in this context.

Background: Chorioamnionitis significantly impacts both maternal and neonatal outcomes. Due to the critical need for rapid management, coordinated interprofessional collaboration is essential to ensure prompt administration of intravenous (IV) antibiotic therapy. Hospital pharmacists hold a strategic capacity to enhance clinical outcomes and reinforce safe medication practices. Aim: To describe IV antibiotics prescribing patterns and assess their clinical appropriateness in the treatment of suspected chorioamnionitis at Women Wellness and Research Center (WWRC), evaluate antibiotic-focused pharmacy interventions, and propose evidence-driven strategies to address identified challenges. Method:: A retrospective chart review of IV antibiotics used for females admitted for labor between 01/07/2024 and 31/12/2024 was conducted. Pharmacists' intervention notes related to prescribed antibiotics were collected and analyzed. Descriptive reporting of findings will be provided. Results: A total of 464 pregnant patients were included. Majority were Arab-speaking (55.2%) and 63.1% were primigravida (n = 293). Modes of delivery included cesarean section (34.9%), normal delivery (31.5%), and assisted normal delivery (22.8% vacuum-assisted, 9.7% forceps-assisted). Only 376 (81.4%) of the reported 460 cases met the diagnostic criteria for suspected chorioamnionitis. All patients included received gentamicin, 97.8% received ampicillin (mean duration 2.8 ± 0.7 days), 15.5% received clindamycin (0.5 ± 0.8 days), 20.5% received metronidazole (2.5 ± 1.7 days), and 3.4% received ceftriaxone (2.4 ± 1.2 days). Usage of more than 2 antibiotics was reported in 135 patients (29%). The most reported intervention performed by IV staff and clinical pharmacists was "dosing/ administration" (68.2% and 31.1%, retrospectively). Gentamicin dosing was corrected in 306 prescriptions (65.9%) out of the 464. Gentamicin dosing algorithm and suspected chorioamnionitis diagnosis checklist have been proposed in this work. Conclusion: Observed deviations from recommended guideline-concordant antibiotic use reveal opportunities for system-level optimization initiatives. The findings underscore pharmacists' crucial contributions in intercepting medication-related inaccuracies and advancing sustainable error-reduction strategies to enhance obstetric antimicrobial stewardship and improve patient safety.