The following is the summary of “Ceftriaxone versus ampicillin for the treatment of community-acquired pneumonia. A propensity matched cohort study” published in the January 2023 issue of clinical microbiology and infections by Guz, et al.

When treating people hospitalized with community-acquired pneumonia (CAP), ceftriaxone is the recommended first-line antibiotic (in conjunction with a macrolide). Clinical outcomes may be equivalent when using a narrower-spectrum -lactam such as ampicillin, and the development of resistant pathogens like Clostridioides difficile infection (CDI) may be reduced. The purpose of this study was to compare the effectiveness of ampicillin and ceftriaxone (with the addition of macrolides for both arms) in treating CAP in hospitalized adults. Observational cohort study with a single research site. Patients over the age of 18 who were diagnosed with CAP while hospitalized and treated with ceftriaxone or ampicillin with a macrolide were included in the study. 

The model employed a propensity score. All-cause mortality at 30 days was the primary endpoint. Multiple logistic regression and Kaplan-Meier analyses of survival were conducted. The primary outcome was broken down by age and CURB-65 score for further examination. Overall, 1,586 patients met the study’s requirements. A comparison of the 30-day death rates between the ampicillin and ceftriaxone groups found no significant difference (P=0.184; 28/233 vs. 208/1,353, respectively). Multivariable analysis of the main model (OR 0.67, 95% CI, 0.37-1.2; P=0.189) and Kaplan-Meier survival analysis (P=0.110) found no significant difference in 30-day all-cause mortality between treatment groups in the propensity-matched cohort (197 in the ampicillin arm and 394 in the ceftriaxone arm). 

The mortality rate at 30 days was 19/197 in the ampicillin group and 57/394 in the ceftriaxone group (P=0.108). The ampicillin group had a considerably lower CDI rate than the placebo group (0/197, 0% vs. 8/394, 2%; P=0.044). In individuals hospitalized with CAP, amoxicillin was associated with similar clinical results to ceftriaxone. This study found that the incidence of CDI was drastically reduced in patients treated with ampicillin. Stronger study designs are needed to verify the findings.