One-time ceftriaxone cuts ventilator-associated pneumonia risk

A single dose of ceftriaxone appears to reduce the risk of developing early ventilator-associated pneumonia (VAP) in patients with acute brain injury, according to the PROPHY-VAP study.

PROPHY-VAP included 345 adult comatose patients (Glasgow Coma Scale score [GCS] ≤2) who required mechanical ventilation for at least 48 hours after acute brain injury. These patients were randomly assigned to receive intravenous ceftriaxone 2 g (n=171) or placebo (n=174) once within the 12 hours following tracheal intubation. None of them underwent selective oropharyngeal and digestive tract decontamination.

Of the patients, 330 received the allocated intervention and 319 were included in the analysis (52 percent women), of which 162 were in the ceftriaxone group and 157 in the placebo group. A total of 93 confirmed cases of VAP were documented, including 74 early infections.

Early VAP occurred less frequently in the ceftriaxone group than in the placebo group (14 percent vs 32 percent). Treatment with ceftriaxone was associated with a 40-percent lower risk of early VAP (hazard ratio, 0.60, 95 percent confidence interval, 0.38–0.95; p=0.030).

Ceftriaxone did not induce significant microbiological impact. Finally, there were no adverse effects attributable to the antibiotic.

Based on the findings, researchers recommended the inclusion of a single dose of ceftriaxone in all bundles for the prevention of VAP in patients with brain injury who require mechanical ventilation.