Reviewed by Jose Lucar, MD, The George Washington University
Selecting the narrowest spectrum antibiotic for a particular clinical indication is a key antimicrobial stewardship principle, however, there are other important and sometimes competing factors to consider when shaping a definitive treatment strategy such as patient experience, safety profile, and cost. For example, clinicians often must consider all of these factors when deciding between a prolonged course of IV ceftriaxone versus IV penicillin for certain infections in which both are appropriate options, including endocarditis and bone and joint infections. In this retrospective multicenter study conducted in Australia (2017-2018), the authors evaluated adult inpatients who were discharged on IV ceftriaxone or IV penicillin and performed a cost analysis in those who could have received either drug based on the indication (primarily focused on drug acquisition & IV access). Of 105 eligible patients, 40 (38%) could have received either drug with an average daily cost of IV ceftriaxone $1.23 Australian dollars (AUD)/day and IV penicillin $93.76 AUD/day, the latter having an annual additional cost of $68K AUD/year. Limitations of the study include lack of safety event and overall tradeoff assessment between ceftriaxone, a broader spectrum but cheaper and more convenient drug, versus penicillin, a narrower but more expensive and less convenient agent.
LKalatharan, L., Ferman, M., Kumar, S., et al. Use of Ceftriaxone and Benzylpenicillin in Outpatient Parenteral Antimicrobial Therapy: Spectrum versus Cost. Open Forum Infectious Diseases, 2023; ofad505