What is the difference in antimicrobial coverage between Unasyn (Ampicillin-Sulbactam) and Rocephin (Ceftriaxone)?

From the Guidelines

Unasyn (ampicillin/sulbactam) is preferred over Rocephin (ceftriaxone) for mixed aerobic/anaerobic infections, while Rocephin is better suited for urinary tract infections, pneumonia, or meningitis due to its excellent gram-negative coverage and CNS penetration. When considering the antimicrobial coverage of Unasyn and Rocephin, it's essential to note that Unasyn provides good coverage against gram-positive organisms, including streptococci and some staphylococci (not MRSA), gram-negative bacteria, and anaerobes 1. In contrast, Rocephin, a third-generation cephalosporin, has excellent gram-negative coverage, including Enterobacteriaceae and some Pseudomonas, but moderate gram-positive coverage and poor anaerobic coverage 1. The choice between these antibiotics should be guided by the suspected pathogens, site of infection, local resistance patterns, and patient factors such as allergies and renal function 1. Some key points to consider when choosing between Unasyn and Rocephin include:

• Unasyn's coverage of beta-lactamase producing organisms due to its beta-lactamase inhibitor component (sulbactam) 1
• Rocephin's better CNS penetration, making it preferred for meningitis, and its longer half-life allowing once-daily dosing 1
• The need for coverage of anaerobes in mixed aerobic/anaerobic infections, where Unasyn would be preferred 1
• The importance of local resistance patterns and patient factors, such as allergies and renal function, in guiding the choice between these antibiotics 1

From the Research

Unasyn vs Rocephin Coverage

• Unasyn (ampicillin-sulbactam) and Rocephin (ceftriaxone) are both antibiotics used to treat various infections.
• The coverage of these antibiotics can be compared based on their spectrum of activity:
  • Rocephin has a broad spectrum of activity against Gram-positive and Gram-negative aerobic, and some anaerobic, bacteria 2, 3.
  • Unasyn also has a broad spectrum of activity, but its effectiveness against certain bacteria, such as Pseudomonas aeruginosa, is limited 4.
• In terms of specific infections:
  • Rocephin has been shown to be effective in treating urinary tract infections, lower respiratory tract infections, skin and soft tissue infections, and meningitis 2, 3.
  • Unasyn has been used to treat diabetic foot infections, but its effectiveness may be limited due to high resistance rates among common Gram-negative rods 4.
• The choice between Unasyn and Rocephin may depend on the specific infection being treated and the local microbiologic data:
  • A study found that a locally-derived algorithm using ceftriaxone (Rocephin) and vancomycin provided better coverage than a guideline-based approach for hospital-acquired pneumonia 5.
  • Another study found that ceftriaxone 1g daily was as effective as other antibiotic regimens for community-acquired pneumonia 6.