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Getting the latest healthcare news for you
Getting the latest healthcare news for you
Cefazolin is emerging as the safer antibiotic choice for Staphylococcus aureus bloodstream infections. A large randomized trial (SNAP) found cefazolin noninferior to antistaphylococcal penicillins for 90-day mortality, while a separate Dutch cohort study confirmed flucloxacillin carries more than twice the risk of acute kidney injury. Together, the evidence strongly favors cefazolin as the preferred first-line agent.
Two new studies are reshaping how clinicians treat methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia — one of the deadliest bacterial infections worldwide, killing more than 1 in 4 patients within 90 days. The international SNAP trial, published in the New England Journal of Medicine, randomized nearly 1,300 adults across 91 sites in eight countries to cefazolin or an antistaphylococcal penicillin (ASP) like flucloxacillin or cloxacillin. Cefazolin proved noninferior for 90-day mortality and was significantly safer on the kidneys.
A separate Dutch retrospective cohort study of 1,408 patients reinforced these findings, showing flucloxacillin was independently associated with more than double the risk of acute kidney injury (AKI) compared to cefazolin. Most AKI cases emerged within the first week of treatment, and recovery rates dropped sharply with increasing severity.
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Why it matters: These findings challenge longstanding guidelines that favored ASPs — partly due to theoretical concerns about a "cefazolin inoculum effect" — and provide robust, real-world evidence that cefazolin is equally effective and meaningfully safer. Experts expect clinical guidelines to be updated to rank cefazolin above cloxacillin and flucloxacillin for MSSA bacteremia.
