A single dose of ceftriaxone within 12 hours of intubation
Control
Placebo
Population
319 analysed patients with acute brain injury, of 345 randomised
Follow-up
28 days
Primary endpoint
Early ventilator-associated pneumonia between day 2 and day 7
Result
A single ceftriaxone dose decreased the risk of early ventilator-associated pneumonia compared with placebo among the 171 and 174 patients randomised to each arm.
Secondary endpoints
Late ventilator-associated pneumonia, antibiotic exposure, mortality, resistance
In patients with acute brain injury, a single ceftriaxone dose decreased the risk of early VAP. On the basis of our findings, we recommend that an early, single dose of ceftriaxone be included in bundles of care.
The trial authors, in the published abstract
How it has aged
A rare positive prophylactic antibiotic result in an era of stewardship, and its appeal is that a single dose is unlikely to drive much resistance. Confined to acute brain injury, where impaired airway protection makes early aspiration pneumonia predictable.
Publications
Ceftriaxone to prevent early ventilator-associated pneumonia in patients with acute brain injury: a multicentre, randomised, double-blind, placebo-controlled, assessor-masked superiority trial
Dahyot-Fizelier C, Lasocki S, Kerforne T, et al. Ceftriaxone to prevent early ventilator-associated pneumonia in patients with acute brain injury: a multicentre, randomised, double-blind, placebo-controlled, assessor-masked superiority trial. Lancet Respir Med 2024 May;12(5):375-385.