2026 Eastern States Conference

Authors
Joseph Lalla, PharmD; Lauren Allen, PharmD, BCIDP; Alex Matika, PharmD, BCIDP; Justin Miller, PharmD; Esrat Jahan, PharmD

Learning Objective
Identify whether oral third generation cephalosporins are as effective as ceftriaxone and vancomycin for the treatment of penicillin-non-susceptible, ceftriaxone-susceptible VGS infections.

Background/Objective
Clinical data regarding oral transition therapy for penicillin-non-susceptible, ceftriaxone-susceptible VGS infections is limited. This study evaluated the effectiveness of cefpodoxime or cefdinir for these infections.

Self-Assessment Question
(True or false): Ceftriaxone and vancomycin are superior to oral-transition therapy with cefdinir or cefpodoxime for the treatment of ceftriaxone-susceptible VGS.

Methods
This retrospective chart review evaluated patients >18 years old admitted to St. Luke’s University Health Network for treatment of penicillin-non-susceptible, ceftriaxone-susceptible VGS infections from January 2017 to December 2025. Patients were included if they received parenteral (IV)-only therapy with ceftriaxone or vancomycin and oral transition therapy with cefpodoxime or cefdinir. Sterile cultures obtained from blood, fluid, and tissue were assessed. Patients were excluded if they had deep-seated and/or polymicrobial infections or were transitioned to comfort/hospice prior to treatment completion. The primary outcome was 90-day all-cause mortality. Secondary outcomes included recurrence of infection, hospital length of stay, and treatment-related adverse events. For analysis of continuous variables, the Student’s T-test or Mann-Whitney U Test were utilized and the Chi-square or Fisher’s exact test were conducted for categorical data.

Results
A total of 409 patients were screened. Of those, 43 were included in the IV-only group and 9 in the oral transition group. The gastrointestinal tract was the most common source of infection among both groups (42.3%) and most had concomitant bacteremia (94.2%). No significant difference in all-cause mortality at 90-days was observed between the IV-only and oral transition therapy groups (9.3% vs. 11.1%; p = 1.00). In patients that received oral-transition therapy, the total duration of definitive therapy was significantly shorter (10 vs. 15 days; p < 0.01). The median hospital length of stay was significantly shorter in the oral-transition group (5 vs. 8 days, p < 0.05). No significant difference in adverse effects was observed between the groups.

Conclusions
It remains unclear if there is a difference in all-cause mortality or recurrence of VGS infections at 90 days between the IV-only and oral transition groups. However, results suggest oral transition therapy with cefpodoxime and cefdinir may significantly reduce median hospital length of stay and total duration of definitive therapy.