From the Guidelines
Ceftaroline does not provide adequate coverage against anaerobic bacteria and should be used in combination with an antibiotic that has good anaerobic activity, such as metronidazole, when treating infections where anaerobic coverage is necessary. Ceftaroline is a fifth-generation cephalosporin with bactericidal activity against gram-positive and negative pathogens, including MRSA and DRSP, as seen in a meta-analysis of three randomized studies including 1916 CAP patients, where ceftaroline was superior to ceftriaxone in patients with severe pneumonia 1. However, its effectiveness against anaerobic bacteria is limited due to its molecular structure and mechanism of action, which targets penicillin-binding proteins that are less critical in anaerobic bacteria. Many anaerobes also produce beta-lactamases that can inactivate ceftaroline.
When treating mixed infections that may involve anaerobes, such as intra-abdominal infections, diabetic foot infections, or aspiration pneumonia, combination therapy or selection of an alternative agent with broader anaerobic coverage would be more appropriate. The choice of antibiotic should be guided by the suspected or confirmed pathogens involved in the infection, as well as local antimicrobial resistance patterns. In the context of community-acquired pneumonia (CAP), the use of ceftaroline has been studied, and it has shown potential as an antibiotic option, especially in patients with resistant pathogens 1. However, its lack of anaerobic coverage is a significant consideration in certain types of infections.
Key points to consider when using ceftaroline include:
- Its effectiveness against gram-positive and negative pathogens, including MRSA and DRSP
- Its limited activity against anaerobic bacteria
- The need for combination therapy with an antibiotic that has good anaerobic activity when treating mixed infections that may involve anaerobes
- The importance of guiding antibiotic choice by the suspected or confirmed pathogens involved in the infection, as well as local antimicrobial resistance patterns.
From the Research
Anaerobic Bacteria Coverage
- Ceftaroline has limited activity against anaerobic bacteria, particularly Bacteroides fragilis group isolates 2, 3, 4, 5.
- However, ceftaroline plus avibactam has demonstrated bactericidal activity against common anaerobic pathogens, including Bacteroides fragilis, Prevotella bivia, and Finegoldia magna 2.
- The in vitro activity of ceftaroline against anaerobic bacteria is variable, with good to excellent activity against Gram-positive anaerobic pathogens, but limited activity against Gram-negative pathogens 3, 4.
- Ceftaroline has been shown to have potent activity against a broad spectrum of anaerobes encountered in respiratory, skin, and soft tissue infections, but its activity against Bacteroides fragilis and non-fragilis Bacteroides spp. is limited 4, 5.
Specific Anaerobic Bacteria
- Bacteroides fragilis: ceftaroline has limited activity against this species 3, 4, 5.
- Prevotella bivia: ceftaroline plus avibactam has demonstrated bactericidal activity against this species, but modest regrowth was observed 2.
- Finegoldia magna: ceftaroline plus avibactam has demonstrated bactericidal activity against this species 2.
- Gram-positive anaerobic pathogens: ceftaroline has good to excellent activity against these pathogens 3, 4.