Length of Hospital Stay in Patients Taking Ceftaroline Fosamil and Ceftriaxone

Anaheim—A pooled analysis of 2 phase 3, double-blind, multinational, randomized controlled studies involving patients with community-acquired pneumonia (CAP) found that those taking ceftaroline fosamil spent less time in hospitals compared with those taking ceftriaxone. However, the results, presented during a poster session at the ASHP meeting, were not statistically significant. The poster was titled Comparison of Hospital Length of Stay Between Ceftaroline (CPT) Fosamil and Ceftriaxone (CRO) Among Patients with Community-Acquired Pneumonia (CAP): Analysis of 2 Phase 3 Randomized Controlled Trials. CAP, a serious respiratory infection, was responsible for >1.1 million hospitalizations in the United States in 2007. The US Food and Drug Administration has approved ceftaroline fosamil to treat patients with community acquired bacterial pneumonia as well as acute bacterial skin and skin-structure infections. The drug had high clinical and microbiologic cure rates in 2 phase 3 trials comparing ceftaroline fosamil and ceftriaxone. In this study, the authors examined the phase 3 trials in which patients were assigned to receive 600 mg of ceftaroline fosamil administered intravenously every 12 hours or 1 g of ceftriaxone administered intravenously every 24 hours. In the first trial, patients also received 500 mg of clarithromycin 2 times on the first day. Patients were excluded if they received an additional oral therapy before the test-of-cure visit or if they were not included in the intent-to-treat population. The authors collected the length of stay in hospitals for patients enrolled at study centers in the United States, Germany, Poland, and Spain because they had similar populations, medical training, clinical practice, and healthcare reimbursement systems. The following were collected for each patient: age, sex, race, principal diagnosis when hospitalized, secondary diagnoses during hospitalization, comorbidities, pneumonia severity variables, baseline pathogens, creatinine clearance, partial pressure of arterial oxygen, and discharge status and destination. The intent-to-treat population included 1240 patients (621 in the ceftaroline fosamil group and 619 in the ceftriaxone group), but the analysis focused on 300 patients from the 4 aforementioned countries. There were 150 patients in each group. The 2 arms had similar characteristics in terms of mean age, sex, race, and comorbidities. The mean length of hospital stay for the ceftaroline fosamil group was 11.5 days compared with 12.2 days for the ceftriaxone group (95% confidence interval [CI] for the treatment difference, −2.2 to 0.9). The authors also evaluated the groups by pneumonia severity as measured by the Pneumona Patient Outcomes Research Team (PORT) risk scores III and IV. The PORT III risk class included 77 patients taking ceftaroline fosamil and 79 patients taking ceftriaxone, while the PORT IV risk group included 73 patients taking ceftaroline fosamil and 71 patients taking ceftriaxone. In the PORT III subanalysis, the mean length of hospital stay for the ceftaroline fosamil group was 11.1 days compared with 12.1 days for the ceftriaxone group (95% CI for the treatment difference, −3.2 to 1.2). In the PORT IV subanalysis, the mean length of hospital stay for the ceftaroline fosamil group was 12.1 days compared with 12.4 days for the ceftriaxone group (95% CI for the treatment difference, −2.6 to 1.9). According to the authors, the study had some limitations. They could only obtain data for approximately 25% of the patients in the 2 trials, and the clinical trial and practice settings may not have been similar. A 2007 discharge survey of hospitals in the United States found the average length of hospital stay for patients with CAP was 5.0 days, compared with 11.8 days in this analysis.