SynthesisEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology2026
A mixed methods approach (EXPANS) to assess current and future uses of antimicrobials: a case study of ceftaroline.
Synthesis in European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeDue to rising antibiotic resistance rates, treating infections becomes more complex. To tackle this, old and new antibiotics will need to be used more frequently for additional indications outside the scope of their original registrations. We aimed to introduce a mixed methods approach to identify off-label indications for antimicrobials in specific settings, and applied this to an antimicrobial not commonly used in the Netherlands, ceftaroline.
methodsWe developed the Exploratory Positioning of Antimicrobials in New Settings (EXPANS) approach, which includes a systematic literature review, an observational study and an expert meeting. We applied our approach to ceftaroline to explore off-label indications and its potential use in outpatient parenteral antimicrobial therapy (OPAT).
resultsIn both the literature and Dutch hospitals, ceftaroline was mainly prescribed as second-line treatment following treatment failure or side effects, often for endocarditis and bone and joint infections. Combination therapy with daptomycin was common, and ceftaroline was used in OPAT. In Dutch hospitals, only 48 patients were prescribed ceftaroline in the last five years. Experts experienced a lack of evidence, reimbursement issues, and the risk of leukopenia as key barriers to its use. Dutch experts noted potential for off-label use of ceftaroline in endocarditis and as prophylaxis for prosthetic joint revision surgery.
conclusionThe components used in our EXPANS approach were complementary, gathering original data on clinical experiences with specific antimicrobials and identifying barriers to their use in practice. We recommend this systematic approach to explore untapped potential of existing antimicrobial agents and optimize their use.
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