Oral Cefadroxil Comparable to IV Antibiotics for Gram-Positive Bacteremia, finds study
Researchers have found in a new study that among patients with gram-positive bacteremia, including those with non-vertebral osteomyelitis, oral cefadroxil achieved treatment success rates comparable to IV and other oral antibiotic regimens. No severe adverse events occurred with cefadroxil, while 90-day mortality, recurrent bacteremia, and readmission rates were similar across treatment groups, suggesting oral cefadroxil may be a potential alternative to prolonged IV therapy in selected patients. The study was published in the Open Forum Infectious Diseases journal by Devin C. and colleagues.
A thorough comparison of the effectiveness of oral cefadroxil compared to existing treatment methods was made based on the results of the multicentric retrospective observation conducted from September 2022 to April 2025. A total of 323 patients aged more than 18 years old with GPC blood stream infections were recruited to the study, forming three different treatment groups: oral cefadroxil (58 patients), IV only group (72 patients) and other oral antibiotics group (193 patients).
Patients with complicated cases of high-risk infection (endocarditis, vertebral osteomyelitis, central nervous system infections, and prosthetic joint infections) were excluded. The 90-day follow-up period was utilized for observations. The primary outcome measure was the treatment success, which was calculated using 90-day survival rate without infection progression and without microbiological relapses. The secondary outcomes included the measures of all-cause 90-day mortality, recurrent bacteremia, readmissions, and adverse drug reactions.
Key findings:
- Amongst the total of 323 adult BSI patients examined, 58 patients were on oral cefadroxil therapy, 72 were on IV-only therapy, and 193 were on other types of oral treatments.
- The frequency of osteomyelitis was almost similar for the groups; however, skin and soft tissue infection was common cause of bacteremia in the cefadroxil group (52%) in comparison to the IV (28%, P = .01) and alternative oral group (31%, P = .003).
- Moreover, Staphylococcus aureus was common in the IV group (60%) in comparison to the cefadroxil group (36%, P = .008), although the case mix index and expected mortality scores were comparable between all the groups.
- Cefadroxil had high success rate of primary therapy (91%), and no difference was observed when compared to the IV only (94%, P = .51) and alternative oral (93%, P = .63) groups.
- There was no significant difference in terms of 90-day all-cause mortality, bacteremia recurrence, 90-day hospital readmission, and drug related adverse effects in all the groups.
Thus, the use of oral cefadroxil is considered an effective and safe therapy for patients who have Gram-positive cocci blood infections, either alone or in combination with nonvertebral osteomyelitis. Cefadroxil therapy shows equal efficiency of treatment as compared with other methods (IV therapy and other alternative therapies) and provides the same percentage of the 90-day outcome (91%).
Reference:
Devin C Clark, Rachel Baden, Josh Banerjee, Rita Bedrossian, Hannah Chute, Kusha Davar, Derek Deng, Matthew Donnelly, Daisy Fernandez, Reid Goodman, Hugh Gordon, Emerson Harris, Douglass Hutcheon, Arthur Jeng, Vaishnavi Kolluru, Pamela Lee, Esteban Martinez, Loren G Miller, Emi Minejima, Vadym Mykhaylov, Madelyn Perez, Dana Russell, Varsha Srinivasa, Ishaque Syed, Noah Wald-Dickler, Brad Spellberg, Sarah R Freling, Cefadroxil as Oral Transitional Therapy for Gram-Positive Bacteremia With or Without Non-Vertebral Osteomyelitis: A Multicenter Retrospective Cohort Study, Open Forum Infectious Diseases, Volume 13, Issue 8, August 2026, ofag413, https://doi.org/10.1093/ofid/ofag413
