A Therapy’s Efficacy and Safety Profile
In this conversation, Sakoulas discusses a specific therapy indicated for CABP.
Contagion: Can you talk about ceftaroline’s efficacy, especially for those with high risk and comorbidities that need the right choice from the start?
Sakoulas: Yes, so ceftaroline is a first-line agent in my community-acquired pneumonia algorithm, primarily because of the illness severity in patients predisposed or at risk for staphylococcal pneumonia. Ceftaroline is an excellent anti-staphylococcal agent with strong in vivo and in vitro coverage against both MSSA and MRSA. Although it doesn’t have an official indication for MRSA pneumonia, that doesn’t mean it isn’t effective. Over the past ten years, I’ve used it successfully in many community-acquired pneumonia cases where patients were severely ill and at risk for MRSA. If the patient starts improving, I continue using ceftaroline even though it’s not formally approved for MRSA pneumonia.
It’s particularly reassuring to see MRSA grown from a sputum or blood culture and know that you’re ahead of the curve, rather than being behind with a standard ceftriaxone-based regimen. While we often focus on its efficacy against staph, ceftaroline also performs well with pneumococcal infections. Clinical trials, specifically focus 1 and focus 2, showed that ceftaroline statistically outperformed ceftriaxone in cases with Streptococcus pneumoniae as the pathogen. This makes sense, as ceftaroline is a potent gram-positive agent, even more so than ceftriaxone. In these trials, ceftriaxone was dosed at 1 gram every 24 hours, but the results suggest that ceftaroline’s superior performance wasn’t a statistical anomaly but rooted in its fundamental microbiologic properties.
Considering Strep pneumoniae is the most common bacterial pathogen in community-acquired pneumonia, using ceftaroline places you ahead in treating this pathogen as well. During respiratory season—when flu, COVID, and other respiratory infections are prevalent—there are strong reasons to prioritize ceftaroline early in the treatment regimen, especially for patients who are severely ill.
Contagion: Can you provide an overview of the safety profile of the therapy?
Sakoulas: Yes, ceftaroline is a cephalosporin, and we’ve been using cephalosporins for decades with a well-known safety profile. Side effects are similar to other cephalosporins, including nausea in about 5% of cases, rash in around 3%, and some GI disturbances. No adverse events were reported in more than 5% of patients who received ceftaroline in the CANVAS and FOCUS trials, which included patients with skin infections and pneumonia. Overall, ceftaroline is well-tolerated, as expected for a cephalosporin. About 5% or fewer patients may experience mild GI disturbances or a drug rash.
Anecdotally, and based on its chemical structure, cross-reactivity with penicillins and other cephalosporins appears to be minimal. This makes it a reasonable option for most penicillin-allergic patients, unless they have a severe allergy.
The conversation was edited for grammar and clarity.
