This article is more than 5 years old. Information may no longer be current.
Lowered ceftriaxone breakpoints may have unintended consequences
Click Here to Manage Email Alerts
Health officials may want to take a second look at the lowered ceftriaxone breakpoints against Enterobacteriaceae because they actually may be boosting broad-spectrum beta-lactam use, according to recently published data.
Pranita D. Tamma, MD, MHS, of the Johns Hopkins Medical Institutions, division of pediatric infectious diseases, department of pediatrics, conducted a retrospective study that compared clinical outcomes of children with Enterobacteriaceae infections treated with either ceftriaxone or broader-spectrum beta-lactams with reduced susceptibility to ceftriaxone using the revised breakpoints (≤1 mcg/mL), but would have been considered susceptible using the pre-2010 breakpoints (≤8 mcg/mL).
“Using the [Clinical and Laboratory Standards Institute] breakpoints prior to 2010, 76 children would have had clinical isolates resistant to ceftriaxone. With the revised breakpoints, 229 Enterobacteriaceae isolates would no longer be susceptible to ceftriaxone (>300% increase),” according to the researchers. “Of the 136 children who met eligibility criteria, 63 children received ceftriaxone and 73 children received broader-spectrum beta-lactams.”
Although the researchers noted no differences at 30 days between the two groups in mortality or microbiological response, they said their study may have lacked statistical power to detect differences between the two groups. They expressed concern about lowering CLSI breakpoints on the basis of very limited clinical data when therapeutic options for these infections are already limited.
“Although our results may not be sufficient to adjust the breakpoints due to our limited sample size, because of the large number of children who will require increasingly broad-spectrum antibiotics, our findings suggest that the benefit of lowered breakpoints for children may need to be re-evaluated,” researchers said. “We realize the [Clinical and Laboratory Standards Institute] are constrained by the limited available clinical data, we believe they should encourage the undertaking of clinical studies to ensure that changing breakpoints are truly in the best interest of patients.”
Pranita D. Tamma, MD, can be reached at Johns Hopkins Medical Institutions,
Division of Pediatric Infectious Diseases, Department of Pediatrics, 200 N. Wolfe St., Suite 3155, Baltimore, MD 21287;phone: 443-287-4099; email:ptamma1@jhmi.edu.
Disclosure: Tamma reports no relevant financial disclosures.
Click Here to Manage Email Alerts