TOPLINE

Oral cefadroxil demonstrated similar treatment success rates compared with intravenous (IV) and alternative oral antibiotics in patients with gram-positive bacteremia, including those with non-vertebral osteomyelitis. No severe adverse events (AEs) occurred in the cefadroxil group, and 90-day mortality, recurrent bacteremia, and readmission rates were comparable across all treatment arms.

METHODOLOGY

• A multicenter retrospective cohort study compared outcomes among 323 adult patients with gram-positive bacteremia treated with oral cefadroxil (58 patients; median age, 54 years; 76% men), IV antibiotics (72 patients; median age, 53.5 years; 75% men), or alternative oral antibiotics (193 patients; median age, 52 years; 69% men) across 4 hospitals in Los Angeles County, California.
• Patients with endocarditis, vertebral osteomyelitis, prosthetic joint infections, or central nervous system infections were excluded from all cohorts to ensure comparable groups.
• Pathogens included methicillin-susceptible Staphylococcus aureus and streptococcal species; 19% of cefadroxil patients, 26% of IV patients, and 17% of alternative oral patients had non-vertebral osteomyelitis.
• Median total antibiotic duration was 16 days for cefadroxil, 28.5 days for IV, and 15 days for alternative oral regimens; both oral cohorts received a median of 5 days of IV lead-in therapy before transitioning, while the IV-only cohort received a median of 8 days of inpatient IV therapy.
• The primary outcome was treatment success, defined as 90-day survival without infection progression or relapse.

TAKEAWAY

• Treatment success rates were similar across groups: 91% for cefadroxil, 94% for IV antibiotics (P = .51), and 93% for alternative oral antibiotics (P = .63).
• The outcome of 90-day mortality was low and comparable between treatment groups: 2% for cefadroxil, 1% for IV (P > .99), and 0.5% for alternative oral antibiotics (P = .41).
• No severe AEs occurred in the cefadroxil group, compared with 3% in the IV group (P = .50) and 2% in the alternative oral group (P = .58).
• Multivariable analysis showed no significant difference in treatment failure odds between cefadroxil and either IV (adjusted odds ratio [aOR], 0.52; 95% CI, 0.14-1.93) or alternative oral regimens (aOR, 0.79; 95% CI, 0.28-2.26).

IN PRACTICE

"Our findings support the use of cefadroxil as a pragmatic option for transitional therapy in lower risk infections," wrote the authors of the study.

SOURCE

The study was led by Devin C. Clark, Los Angeles General Medical Center in Los Angeles. It was published online on August 10 in Open Forum Infectious Diseases.

LIMITATIONS

The retrospective observational design introduced susceptibility to unmeasured confounding and selection bias. Baseline imbalances existed between the treatment arms. Findings should not be extrapolated to high-risk sources such as endocarditis or vertebral osteomyelitis, which were excluded. 

DISCLOSURES

No specific funding was reported. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.