21.02.2025

Guidance on cephalosporins for Staphylococcus aureus infections

Updated guidance on the use of and dosing of cephalosporins for S. aureus infections.

Various cephalosporins have been used for many years for treatment of a variety of infections caused by MSSA. The third-generation cephalosporins, cefotaxime and ceftriaxone, have been used in selected instances of more serious MSSA infections, such as allergy to penicillins, mixed infections, and in the case of ceftriaxone, as stepdown outpatient parenteral antimicrobial therapy (OPAT). Their use in these settings is controversial given their ecological impact on the gut microbiome and their resistance selection pressure. Ceftriaxone has become widely used in some countries for outpatient intravenous therapy because it permits once-daily dosing.

EUCAST has reviewed the PK/PD of the intravenous agents and the data on clinical outcomes for both oral and intravenous agents to determine if the current recommendation that S. aureus susceptibility to these agents can be inferred provided that the isolates are phenotypically (cefoxitin susceptible) or genotypically negative for the presence of mecA or mecC.