Comparative outcomes of β-lactam antibiotics in outpatient parenteral antibiotic therapy: treatment success, readmissions and antibiotic switches

Lee, Boeun; Tam, Idy; Weigel, Bernard; Breeze, Janis L.; Paulus, Jessica K.; Nelson, Jason; Allison, Genève

doi:10.1093/jac/dkv130

Cited by 46 publications

(46 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Finally, we demonstrated that patients who received nafcillin were more likely to discontinue therapy due to adverse events than were patients who received oxacillin. These data corroborate results of previous studies evaluating the tolerability of nafcillin or oxacillin among outpatients (18,19). Consensus guidelines recommend nafcillin or oxacillin as a first-line treatment for MSSA infections without a preference between the agents (5,6).…”

Section: Discussionsupporting

confidence: 87%

“…The UPMC is a tertiary-care referral center that houses highly dynamic, critically ill patients. Rates of adverse events reported here should not be directly compared to those among patients receiving OPAT (18,19). Furthermore, we cannot definitively comment on differences in the long-term tolerabilities of nafcillin and oxacillin.…”

Section: Discussionmentioning

confidence: 84%

“…Previous studies evaluating the tolerability of antistaphylococcal penicillins have not included electrolyte imbalances as an endpoint (18,19). This is noteworthy given that hypokalemia was the most common adverse event identified in our study.…”

Section: Discussionmentioning

confidence: 88%

“…On the other hand, the semisynthetic penicillins may be replaced altogether for patients who cannot be routinely monitored. Accumulating evidence suggests that cefazolin may be a better-tolerated alternative to both nafcillin and oxacillin (18,19,26,27). These findings will need to be balanced with practical considerations like cost and administration of the agents.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Adverse Events Lead to Drug Discontinuation More Commonly among Patients Who Receive Nafcillin than among Those Who Receive Oxacillin

Viehman

Oleksiuk

Sheridan

et al. 2016

Antimicrob Agents Chemother

View full text Add to dashboard Cite

b Nafcillin and oxacillin are used interchangeably in clinical practice, yet few studies have evaluated the safety of these two agents. Our objective was to compare the differential tolerabilities of nafcillin and oxacillin among hospitalized patients. We conducted a retrospective cohort study of all patients who received 12 g/day of nafcillin or oxacillin for at least 24 h. Two hundred twentyfour patients were included. Baseline characteristics and comorbidities were similar among patients receiving nafcillin (n ‫؍‬ 160) and those receiving oxacillin (n ‫؍‬ 64). Hypokalemia, defined as a potassium level of <3.3 mmol/liter or <2.9 mmol/liter or as a >0.5-mmol/liter decrease from the baseline level, occurred more frequently among patients who received nafcillin (51%, 20%, and 56%, respectively) than among those who received oxacillin (17%, 3%, and 34%, respectively; P < 0.0001, P ‫؍‬ 0.0008, and P ‫؍‬ 0.005, respectively). By multivariate logistic regression analysis, receipt of nafcillin was an independent predictor of severe hypokalemia (odds ratio [OR] ‫؍‬ 6.74; 95% confidence interval [CI], 1.46 to 31.2; P ‫؍‬ 0.02). Rates of hepatotoxicity did not differ between groups; however, acute kidney injury occurred more commonly with nafcillin than with oxacillin (18% versus 6%; P ‫؍‬ 0.03). Overall, 18% of patients who received nafcillin discontinued therapy prematurely due to adverse events, compared to 2% of patients who received oxacillin (P ‫؍‬ 0.0004). Nafcillin treatment is associated with higher rates of adverse events and treatment discontinuation than oxacillin among hospitalized adult patients. These findings have important implications for patients in both inpatient and outpatient settings, particularly patients who require long-term therapy and cannot be monitored routinely. Future randomized controlled studies evaluating the efficacy, costs, and tolerability of nafcillin versus oxacillin are warranted.

show abstract

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Adverse Events Lead to Drug Discontinuation More Commonly among Patients Who Receive Nafcillin than among Those Who Receive Oxacillin

Viehman

Oleksiuk

Sheridan

et al. 2016

Antimicrob Agents Chemother

View full text Add to dashboard Cite

show abstract

“…Search results. The database search process identified 475 articles; 11 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) were included in the analysis of hospitalized patients, and 3 (23)(24)(25) were included in the analysis of outpatients (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

Systematic Review and Meta-analysis of the Safety of Antistaphylococcal Penicillins Compared to Cefazolin

Eljaaly

Alshehri

Erstad

2018

Antimicrob Agents Chemother

View full text Add to dashboard Cite

Recent studies and experience suggest that cefazolin might be equally as effective as antistaphylococcal penicillins for methicillin-susceptible (MSSA), with a better safety profile and lower cost. The objective of these meta-analyses was to compare the safeties of antistaphylococcal penicillins and cefazolin. The PubMed, Embase, and International Pharmaceutical Abstracts databases and websites for clinical trial registries through 23 June 2017 were searched. In addition, recent abstracts from infectious disease and pharmacy conferences were reviewed. We estimated Peto odds ratios (ORs) with 95% confidence intervals (CIs) using random-effects models. One analysis focused on hospitalized patients, and the other focused on outpatients. Eleven retrospective studies of hospitalized patients and three retrospective studies of outpatients were included. In hospitalized patients, lower rates of nephrotoxicity (Peto OR, 0.225; 95% CI, 0.127 to 0.513), acute interstitial nephritis (Peto OR, 0.189; 95% CI, 0.053 to 0.675), hepatotoxicity (Peto OR, 0.160; 95% CI, 0.066 to 0.387), and drug discontinuation due to adverse reactions (Peto OR, 0.192; 95% CI, 0.089 to 0.414) were found with cefazolin. In outpatients, lower rates of nephrotoxicity (Peto OR, 0.372; 95% CI, 0.192 to 0.722), hepatotoxicity (Peto OR, 0.313; 95% CI, 0.156 to 0.627), and hypersensitivity reactions (Peto OR, 0.372; 95% CI, 0.201 to 0.687) were observed with cefazolin. Compared to antistaphylococcal penicillins, cefazolin was associated with significant reductions in nephrotoxicity and hepatotoxicity in hospitalized patients and outpatients. Additionally, cefazolin was associated with lower likelihoods of discontinuation due to side effects in hospitalized patients and hypersensitivity reactions in outpatients. Cefazolin should be considered a first-line option for patients with MSSA infections for which efficacy is presumed to be similar to that of antistaphylococcal penicillin therapy.

show abstract

β‐Lactam Therapy for Methicillin‐Susceptible Staphylococcus aureus Bacteremia: A Comparative Review of Cefazolin versus Antistaphylococcal Penicillins

Echevarria

Traugott

2017

Pharmacotherapy

View full text Add to dashboard Cite

Methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia is associated with high morbidity and mortality. Traditionally, antistaphylococcal penicillins (ASPs) have been considered the agents of choice for the treatment of MSSA bacteremia. Vancomycin has been demonstrated to have poorer outcomes in several studies and is only recommended for patients with severe penicillin allergies. Although cefazolin is considered as an alternative to the ASPs for patients with nonsevere penicillin allergies, cefazolin offers several pharmacologic advantages over ASPs, such as more convenient dosing regimens, and antimicrobial stewardship programs are increasingly using cefazolin as the preferential agent for MSSA infections as part of cost-saving initiatives. Concerns about susceptibility to hydrolysis by type A β-lactamases, particularly at high inocula seen in deep-seated infections such as endocarditis; selective pressures from unnecessary gram-negative coverage; and lack of comparative clinical data have precluded recommending cefazolin as a first-line therapy for MSSA bacteremia. Recent clinical studies, however, have suggested similar clinical efficacy but better tolerability, with lower rates of discontinuation due to adverse drug reactions, of cefazolin compared with ASPs. Other variables, such as adequate source control (e.g., intravascular catheter removal, debridement, or drainage) and enhanced pharmacodynamics through aggressive cefazolin dosing, may mitigate the role of cefazolin inoculum effect and factor into determining improved clinical outcomes. In this review, we highlight the utility of cefazolin versus ASPs in the treatment of MSSA bacteremia with a focus on clinical efficacy and safety.

show abstract

Comparative outcomes of β-lactam antibiotics in outpatient parenteral antibiotic therapy: treatment success, readmissions and antibiotic switches

Cited by 46 publications

References 42 publications

Adverse Events Lead to Drug Discontinuation More Commonly among Patients Who Receive Nafcillin than among Those Who Receive Oxacillin

Adverse Events Lead to Drug Discontinuation More Commonly among Patients Who Receive Nafcillin than among Those Who Receive Oxacillin

Systematic Review and Meta-analysis of the Safety of Antistaphylococcal Penicillins Compared to Cefazolin

β‐Lactam Therapy for Methicillin‐Susceptible Staphylococcus aureus Bacteremia: A Comparative Review of Cefazolin versus Antistaphylococcal Penicillins

Contact Info

Product

Resources

About