| Related Articles |
Comparative Evaluation of the Tolerability of Cefazolin and Nafcillin for Treatment of Methicillin-Susceptible Staphylococcus aureus Infections in the Outpatient Setting.
Clin Infect Dis. 2014 Apr 29;
Authors: Youngster I, Shenoy ES, Hooper DC, Nelson SB
Abstract
Background. Nafcillin and cefazolin are considered first-line therapy for most infections with methicillin-susceptible Staphylococcus aureus (MSSA), and recent studies have suggested similar clinical efficacy. Limited data are available on the comparative tolerability of these agents. Methods. A retrospective cohort analysis of patients treated with either nafcillin or cefazolin for MSSA infection in the outpatient parenteral antimicrobial therapy clinic at Massachusetts General Hospital from 2007-2011. The frequency of premature antimicrobial discontinuation (PAD) and drug-emergent events (DEEs) were calculated. Results. Three hundred sixty-six and 119 patients were treated with nafcillin or cefazolin, respectively. Median anticipated duration of therapy was comparable at 28 (IQR 16-37) and 29 (IQR 24-39) days respectively for those treated with nafcillin and cefazolin. Fewer patients completed the pre-specified treatment course with nafcillin (33.8% PAD rate) than with cefazolin (6.7%; p<0.0001). The hazard ratio for PAD in the nafcillin versus cefazolin groups was 2.81 (95%CI 1.26-3.68). More patients in the nafcillin group developed rash (13.9% versus 4.2%; p=0.002), renal dysfunction (11.4% vs. 3.3%; p=0.006) and liver function abnormalities (8.1% versus 1.6%; p=0.01). Overall rates of DEEs per 1000 patient-days were 16.9 (95%CI 10.4-27.3) and 4.8 (95%CI 1.1-10.2), respectively. In nine cases of nafcillin discontinuation, treatment was changed to cefazolin; all nine completed treatment with no further observed DEE. Conclusions. Nafcillin treatment was associated with higher rates of both PAD as well as DEEs compared to cefazolin treatment. This difference in tolerability, in addition to efficacy and cost, should be considered when decisions for outpatient parenteral MSSA treatment are made.
PMID: 24785233 [PubMed - as supplied by publisher]