What is the role of ceftriaxone (Rocephin) and ceftibuten (Cedax) in intravenous-to-oral switch therapy?

Updated: Jul 30, 2018
  • Author: Shirin A Mazumder, MD, FIDSA; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Fernandez and San Martin studied 40 patients admitted to the hospital because of CAP. Initially, these patients were treated with intravenous ceftriaxone (1 g/d) and showed clinical improvement after 3 days of therapy. They were randomly assigned to continue intravenous ceftriaxone therapy for a total of 10 days or to switch to ceftibuten (400 mg/d) for 7 days. Twenty-one of the patients continued intravenous treatment, and 19 were switched to ceftibuten. In terms of clinical cure, radiological improvement, and normalization of WBC count, no differences were noted between the 2 groups. [35] These findings support the viability of switch therapy in this context.

Ceftriaxone (Rocephin) is a third-generation cephalosporin with broad-spectrum, gram-negative activity. It has lower efficacy against gram-positive organisms. Ceftriaxone arrests bacterial growth by binding to one or more penicillin-binding proteins. In adults with uncomplicated infections, dosing is 250 mg IM once, not to exceed 4 g. In adults with severe infections, dosing is 1-2 g IV qd or divided bid, not to exceed 4 g/d. In neonates >7 days, dosing is 25-50 mg/kg IV/IM qd, not to exceed 125 mg/d. Dosing in infants and children is 50-75 mg/kg IV/IM qd divided q12h, not to exceed 2 g/d. Ceftriaxone is a pregnancy category B medication.

Ceftibuten (Cedax) is a third-generation bactericidal cephalosporin that inhibits cell-wall mucopeptide synthesis. In adults, dosing is 400 mg PO qd for 10 d, not to exceed 400 mg/d. If the CrCl is 30-49 mL/min, administer 4.5 mg/kg or 200 mg PO qd. If the CrCl is < 30 mL/min, administer 2.25 mg/kg or 100 mg PO qd. In children < 12 years, dosing is 9 mg/kg PO qd for 10 d, not to exceed 400 mg/d. Administer as in adults in children >12 years. Ceftibuten is a pregnancy category B drug.

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