Off-label use of ceftaroline fosamil: A systematic review

Int J Antimicrob Agents. 2019 Nov;54(5):562-571. doi: 10.1016/j.ijantimicag.2019.06.025. Epub 2019 Jul 3.

Abstract

Ceftaroline fosamil is a fifth-generation cephalosporin with anti-methicillin-resistant Staphylococcus aureus (MRSA) activity. It has been approved by the EMA and FDA for the treatment of adults and children with community-acquired bacterial pneumonia (CABP) and acute bacterial skin and skin structure infections (ABSSSI). However, ceftaroline fosamil has a broad spectrum of activity, and a good safety and tolerability profile, so is frequently used off-label. The aim of this systematic review was to summarize the safety and efficacy of off-label use of ceftaroline. The review was conducted according to PRISMA guidelines. MEDLINE, EMBASE and CENTRAL databases (2010-2018) were searched using as the main term ceftaroline fosamil and its synonyms in combination with names of infectious diseases of interest. A total of 21 studies with 1901 patients were included: the most common off-label indications for ceftaroline use were bacteremia (n=595), endocarditis (n=171), osteoarticular infections (n=368), hospital-acquired pneumonia (n=115) and meningitis (n=23). The most common reasons for off-label use were persistent or recurrent infection after standard treatment or non-susceptibility to vancomycin and daptomycin. Clinical success was evaluated in 933 patients, and 724 (77%) of these reached this positive outcome. Incidence of adverse events (AEs) was reported in 11 studies. In 83 (9%) cases there were AEs related to the use of ceftaroline; the most common reported AEs were nausea, vomiting, diarrhea, rash and neutropenia. The review results show that ceftaroline may be used in clinical settings other than those currently approved; however, the use of ceftaroline in these contexts deserves further investigation.

Keywords: Bacteremia; Ceftaroline fosamil; Endocarditis; MRSA; Meningitis; Off-label.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Bacteremia / drug therapy
  • Bacteremia / microbiology
  • Ceftaroline
  • Cephalosporins / therapeutic use*
  • Community-Acquired Infections / drug therapy*
  • Community-Acquired Infections / microbiology
  • Cross Infection / drug therapy*
  • Endocarditis, Bacterial / drug therapy
  • Endocarditis, Bacterial / microbiology
  • Healthcare-Associated Pneumonia / drug therapy
  • Healthcare-Associated Pneumonia / microbiology
  • Humans
  • Meningitis / drug therapy
  • Meningitis / microbiology
  • Off-Label Use / statistics & numerical data*

Substances

  • Anti-Bacterial Agents
  • Cephalosporins