Ceftriaxone is an empirical
antibiotic commonly used to treat
pneumonia. However, its use to treat
infections caused by
methicillin-susceptible Staphylococcus aureus (MSSA) is controversial given limited evidence of its clinical efficacy. The objective of this study was to compare the clinical efficacy of
ceftriaxone with either
ceftaroline or
ceftobiprole in the treatment of
pneumonia caused by MSSA. A systematic review and meta-analysis of randomised controlled trials (RCTs) comparing clinical cure in patients with
pneumonia who received
ceftriaxone versus those who received either
ceftaroline or
ceftobiprole was conducted. Patients who received
ceftriaxone plus
vancomycin were excluded. The PubMed, Embase and Cochrane Library databases as well as clinical trial registries were searched up to 8 June 2018. Risk differences (RDs) with 95% confidence intervals (CIs) were estimated using a random-effects model and assessing for heterogeneity (I2). A total of five RCTs met the inclusion criteria; four used
ceftaroline and one used
ceftobiprole. Four studies included adults and one included paediatric patients. The adult studies included non-intensive care unit patients with mild-to-moderate community-acquired
pneumonia. Clinical cure was statistically lower with
ceftriaxone (RD, -28.5%, 95% CI -53.5% to -3.4%; P = 0.026; I2 = 16.321%) than with
ceftaroline or
ceftobiprole. In conclusion,
ceftriaxone use was associated with higher clinical failure of MSSA
pneumonia compared with
ceftaroline or
ceftobiprole. This supports the notion that
ceftriaxone is not an ideal agent for the treatment of MSSA
infections and adds new evidence against its use for MSSA
pneumonia.