Background: Ceftaroline fosamil is a cephalosporin approved for treating skin and soft tissue infections (SSTIs), including those caused by methicillin-resistant Staphylococcus aureus (MRSA), and community acquired pneumonia. Given its broad-spectrum activity, its use has expanded. We studied indications for use, adverse drug reactions (ADRs), clinical outcomes, and tolerability in patients with prior report of beta-lactam allergy at two large academic health centers.
Methods: We performed a retrospective electronic health record review of all patients admitted to the Massachusetts General Hospital and Brigham and Women's Hospital who received one or more doses of ceftaroline between May 2012 and February 2015. Patient demographics, comorbidities, antibiotic doses, indications for use, microbiologic data, and drug allergy history were collected. ADRs and tolerability were assessed by allergy specialists; clinical outcomes were assessed by infectious disease specialists for patients receiving ceftaroline for a majority of their treatment course defined as > 50% of days of therapy.
Results: We identified 96 patients who received a median of 28 [IQR 6, 63] ceftaroline doses. Indications for ceftaroline therapy included bacteremia (35%), orthopedic infections (28%), SSTIs (28%), and pneumonia (22%). MRSA was identified in 54% of patient cultures. ADRs occurred in 24/96 (25%), with hematologic (14%) and cutaneous (10%) manifestations most common. Patients with an ADR had a longer median duration of therapy than those without an ADR (46 vs. 23 doses, p=0.008). Of the 96 patients, 42 (44%) received ceftaroline for the majority of the treatment course; of these 31 (74%) had treatment success (Figure 1). Among the 26 patients with prior beta-lactam allergy, including four with reported history of penicillin anaphylaxis, 25 (96%) tolerated ceftaroline without ADR.
Conclusion: Ceftaroline is used to treat a wide range of invasive infections. Treatment success was observed in three quarters of patients. We found that 25% suffered an ADR, higher than reported in premarketing studies. Patients who developed an ADR received more doses of ceftaroline than those who did not. Among patients with a reported history of beta-lactam allergy, ceftaroline was largely tolerated.
A. Weil, None
C. Varughese, None
D. W. Kubiak, None
A. Banerji, None
E. S. Shenoy, None