Comparison of ceftriaxone plus macrolide and ampicillin/sulbactam plus macrolide in treatment for patients with community-acquired pneumonia without risk factors for aspiration: an open-label, quasi-randomized, controlled trial

Abstract

Background: Ceftriaxone (CTRX) and ampicillin/sulbactam (ABPC/SBT) are recommended by various guidelines as the first-line antibiotics for community-acquired pneumonia (CAP). However, which of these antibiotics is more effective for treating non-aspiration CAP remains unclear. Methods: This study was a prospective, single-center, open-label, quasi-randomized controlled trial. Patients with adult CAP without risk for aspiration were allocated to either a CTRX or ABPC/SBT group based on the date of hospital admission. Macrolide was added to patients in each group. The primary outcome was the clinical response in the validated per-protocol (VPP) population at end of treatment (EOT). The secondary outcomes were clinical response during treatment and at end of study (EOS) in the VPP population, and mortality rate at day 30 in the modified intention-to-treat (MITT) population.

Comparison between Ceftriaxone and Sulbactam-Ampicillin as Initial Treatment of Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis

“…Figure 1 shows the full list of exclusion criteria. Eventually, four studies met our inclusion criteria [ 19 , 20 , 21 , 22 ].…”

“…To date, three retrospective studies have compared the efficacy of ceftriaxone with that of sulbactam-ampicillin in the treatment of CAP [ 19 , 20 , 21 ]. Moreover, a prospective study was recently published [ 22 ].…”

Comparative efficacy of azithromycin versus clarithromycin in combination with beta-lactams to treat community-acquired pneumonia in hospitalized patients: a systematic review

“…The results showed a significantly higher effectiveness rate at day 7 in the ampicillin-sulbactam group (p ¼ 0.047) compared with the ceftriaxone group in the validated per-protocol population. 33 Multiple factors supported the superiority of combination therapy. For example, combination therapy can include two mechanisms of action so that the medications work at different sites of bacterial action, such as a beta-lactam that inhibits cell wall synthesis and a macrolide that inhibits protein synthesis.…”

Mortality and clinical cure rates for pneumonia: a systematic review, meta-analysis, and trial sequential analysis of randomized control trials comparing bactericidal and bacteriostatic antibiotic treatments

“…Of these, 18072 were excluded based on title/abstract. Of the remaining sixty-five studies, seventeen were excluded after full-text review as they included comparisons either between different bactericidal or bacteriostatic antimicrobial agents and overlapping data from other trials [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] (Supplemental Table 1). A further four studies were excluded on this basis and results of the meta-analysis were updated accordingly [29][30][31][32].…”