P-664. Comparison of Ceftriaxone vs. Ampicillin Sulbactam for the Treatment of Community Acquired Pneumonia

TL;DR

This study compares two antibiotics for treating pneumonia and finds they have similar effectiveness in reducing mortality.

Contribution

The study provides clinical evidence supporting the equivalence of ceftriaxone and ampicillin-sulbactam for treating CAP.

Findings

No significant difference in 30-day mortality between ceftriaxone and ampicillin-sulbactam.

In-hospital mortality was also not significantly different between the two treatments.

Abstract

Community-acquired pneumonia (CAP) is a leading cause of hospitalization and mortality in the United States, accounting for over 4.5 million healthcare visits annually. Ceftriaxone and ampicillin-sulbactam are commonly recommended β-lactams for hospitalized patients with non-severe CAP. However, direct comparisons of their clinical effectiveness remain limited. This study aims to compare clinical outcomes in hospitalized adults with CAP treated with ceftriaxone versus ampicillin-sulbactam.Table 1:Demographics by Treatment for Matched DataTable 2:Outcomes by Treatment for Matched data

Demographics by Treatment for Matched Data

Outcomes by Treatment for Matched data

This was a retrospective propensity -matched cohort study that included a total of n= 10,640 patients admitted to Henry Ford Hospital in Detroit, Michigan for treatment of CAP between January 2022 through August of 2024. The primary outcomes were in-hospital mortality and 30-day mortality. Descriptive statistics were used to summarize patient demographics, comorbidities, and outcomes for both treatment groups. Propensity score matching was used to account for confounding differences between treatment groups. A logistic regression was used to determine the association between covariates of interest and their association with in-hospital mortality or 30-day mortality.

A total of n=3,171 patients received ampicillin-sulbactam and n=7,469 received ceftriaxone. After propensity score matching, there was a total of n=6,342 patients with an equal number of (n= 3,171) patients in each treatment group. Overall, 4.5% of patients expired in hospital and 11% expired within 30 days. Among this cohort, 30-day readmission was 12.6% and 60-day readmission was 19.4%. Among the propensity-matched patients, there was no significant difference in 30-day mortality between those treated with ceftriaxone and ampicillin-sulbactam (OR 1.065, 95% CI 0.906–1.254, p=0.445). The adjusted OR for in hospital mortality was 1 (95% CI 0.99-1.01, p=0.9894).

This study demonstrates no significant differences in 30-day mortality or in-hospital mortality, between patients treated with ceftriaxone and those treated with ampicillin-sulbactam. These findings support the current IDSA recommendations for therapy showing clinical equivalence of both agents as empiric treatment options for CAP.

Marcus Zervos, MD, merck: Honoraria

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