Ceftriaxone 1 g vs 2 g in the treatment of intra-abdominal infection – an analysis of 965 cases

Background: Secondary peritonitis is closely linked to high in-hospital morbidity, which often leads to mortality in approximately 6% of cases. There is no consensus on whether a 2 g daily dose of ceftriaxone is necessary for treating peritonitis. Objective: This study aimed to compare the efficacy of ceftriaxone 1 g and 2 g daily for community-acquired intra-abdominal infection (CA-IAI). Methods: We retrospectively analyzed the non-inferiority of 1 g versus 2 g of ceftriaxone daily as empirical treatment for CA-IAI. Mortality was the primary outcome measure in this study. The secondary outcomes were hospital readmission, abdominal fistula, and antibiotic escalation. Results: Mortality and antibiotic escalation did not differ between group 1 g and 2 g (6.3% vs. 5.0%, P = 0.40; 5.8% vs. 6.2%, P = 0,89). The proportion of readmitted patients was significantly greater in the 1 g group (5.8% vs. 2.8%. P = 0.02). In the 1 g group, patients were older (45.0 vs 38.0 years, P <0.001), Charlson score was higher (P = 0.001), and the proportion of with diabetes and neoplasms was also higher (9.5% vs. 5.8%, P=0.04; 2.8% vs. 0.8%, P = 0.02), as was the population of those who received one day less of ceftriaxone treatment (P <0.001). Conclusions: Empirical treatment for CA-IAI with ceftriaxone 1 g daily in hospitalized patients was similar to that with ceftriaxone 2 g daily in terms of treatment failure.