1975. 1 g vs. 2 g Daily Intravenous Ceftriaxone in the Therapy of Community-onset Pneumonia: A Propensity Score Analysis From a Data of Japanese Multicenter Registry

BACKGROUND: Community-acquired pneumonia (CAP) is one of the most common infectious diseases and is an important cause of mortality and morbidity worldwide. The prognosis of CAP in adults is associated with factors such as age, comorbidities, vital signs, laboratory data, and other factors on admission. Usually, ceftriaxone (CTRX) is used to treat CAP. However, whether 1 or 2 g of CTRX daily has better efficacy remains unclear. METHODS: This study is an analysis of prospectively registered data from four Japanese hospitals for patients with community-onset pneumonia (COP) from September 2011 to August 2014 (the Adult Pneumonia Study Group-Japan: APSG-J). Subjects who were initially treated solely with 1 g or 2 g of CTRX were enrolled. Propensity score was estimated from the 33 pretreatment variables including age, sex, weight, comorbidities, medications, risk factors for aspiration, whether background was consistent with CAP or not, vital signs, laboratory data, and findings of a chest x-ray. The primary endpoint was cure rate, for which a noninferiority analysis was performed with a margin of 0.05. The secondary outcomes included in-hospital mortality, duration of antibiotic treatment, and length of hospital stay, which were assessed using superiority analyses. RESULTS: Of the 3,817 adult subjects with pneumonia who were registered in the APSG-J study, 290 and 216 were initially treated solely with 1 g or 2 g of CTRX, respectively. Propensity score matching was used to finally extract 175 subjects in each group. Overall, the cure rate was 94.6% in the 1 g group and 93.1% in the 2 g group (risk difference, 1.5 percentage points; 95% confidence interval [CI], −3.1 to 6.0; P = 0.009 for noninferiority). The in-hospital mortality rate was 4.7% and 4.0% (P = 0.740 for superiority), length of hospital stay was 17 and 26 days (P < 0.001 for superiority), and duration of antibiotic treatment was 8 and 10 days (P = 0.002 for superiority) in the 1 g and 2 g groups, respectively. CONCLUSION: Propensity score-matched analysis of multicenter cohort data from Japan revealed that the cure rate for COP patients treated with 1 g of CTRX was noninferior to that in the patients treated with 2 g of CTRX. DISCLOSURES: All authors: No reported disclosures.