Allen, John M., et al. “Cefazolin Versus Anti-Staphylococcal Penicillins for the Treatment of Patients With Methicillin-Susceptible Staphylococcus Aureus Infection: a Meta-Analysis With Trial Sequential Analysis.” Infectious Diseases and Therapy, vol. 8, no. 4, 2019, pp. 671-686.

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This one is not groundbreaking but nice to have data supporting our decisions. This was a review of the literature evaluating the efficacy of cefazolin vs anti-staphylococcal penicillin (cloxacillin, nafcillin, flucoxacillin) in staph aureus bacteremia. The primary end point was 90d all cause mortality; secondary end point was 30d all cause mortality, treatment failure/relapse, and nephrotoxicity. They analyzed 14 studies, most of which were single center and all but one retrospective cohort studies. One thing to note was the fact that cefazolin was used less frequently in IE.

Here are the forest plots:

Seems there is no difference in 90d mortality, though 30d mortality favors cefazolin a bit. Of course, it shouldn’t be surprising that cefazolin tends to be less nephrotoxic (about a third per this analysis). Of course, the elephant in the room is the Eagle effect. They also analyzed patients who had infective endocarditis and abscesses (i.e those who would theoretically have a higher bacterial load):

Again, this is not groundbreaking by any means, but it is nice to have some data to back up the use of cefazolin. So the next time someone says “what about the eagle effect?” You can reply there is no patient centered data to reflect that is clinically significant 😊.

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