Outcomes of ceftriaxone 2 g versus 1 g daily in hospitalized patients with pneumonia: a nationwide retrospective cohort study.

objectivesCeftriaxone is widely used for hospitalized patients with community-acquired pneumonia, but its optimal dosage remains unclear.

methodsWe retrospectively identified patients diagnosed with pneumonia between July 2010 and March 2022 from the Diagnosis Procedure Combination inpatient database in Japan. They were categorized into those receiving 2 or 1 g/day of ceftriaxone within the first 2 days of hospitalization. The primary outcome was 30-day in-hospital mortality. The secondary outcomes included overall adverse events (composite of biliary tract infection, Clostridioides difficile infection and allergic reactions) and each adverse event. A subgroup analysis was conducted for patients requiring mechanical ventilation. Propensity-score overlap-weighting analysis was used for comparisons.

resultsAmong the 471 694 eligible patients, 63.3% received 2 g/day and 36.7% received 1 g/day of ceftriaxone. Propensity-score analysis showed no significant difference in 30-day in-hospital mortality between the two groups [4.5% versus 4.6%; risk difference (RD), -0.1%; 95% confidence interval (CI), -0.3% to 0.1%; P = 0.219]. Overall adverse events were slightly higher in the 2 g/day group (1.9% versus 1.8%; RD, 0.1%; 95% CI, 0.0%-0.2%; P = 0.007), particularly the proportion of C. difficile infection. In the subgroup analysis of patients requiring mechanical ventilation, the 2 g/day regimen was associated with lower 30-day mortality (17.2% versus 20.4%; RD, -3.2%; 95% CI, -5.6% to -0.9%; P = 0.006).

conclusionsWhile a ceftriaxone dose exceeding 1 g/day may not be necessary for routine pneumonia treatment, a 2 g/day regimen may be considered for patients with severe pneumonia requiring mechanical ventilation.