{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T01:27:38Z","timestamp":1792286858568,"version":"4.4.0"},"reference-count":32,"publisher":"American Society for Microbiology","issue":"4","license":[{"start":{"date-parts":[[2018,4,1]],"date-time":"2018-04-01T00:00:00Z","timestamp":1522540800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            Recent studies and experience suggest that cefazolin might be equally as effective as antistaphylococcal penicillins for methicillin-susceptible\n            <jats:named-content content-type=\"genus-species\">Staphylococcus aureus<\/jats:named-content>\n            (MSSA), with a better safety profile and lower cost. The objective of these meta-analyses was to compare the safeties of antistaphylococcal penicillins and cefazolin. The PubMed, Embase, and International Pharmaceutical Abstracts databases and websites for clinical trial registries through 23 June 2017 were searched. In addition, recent abstracts from infectious disease and pharmacy conferences were reviewed. We estimated Peto odds ratios (ORs) with 95% confidence intervals (CIs) using random-effects models. One analysis focused on hospitalized patients, and the other focused on outpatients. Eleven retrospective studies of hospitalized patients and three retrospective studies of outpatients were included. In hospitalized patients, lower rates of nephrotoxicity (Peto OR, 0.225; 95% CI, 0.127 to 0.513), acute interstitial nephritis (Peto OR, 0.189; 95% CI, 0.053 to 0.675), hepatotoxicity (Peto OR, 0.160; 95% CI, 0.066 to 0.387), and drug discontinuation due to adverse reactions (Peto OR, 0.192; 95% CI, 0.089 to 0.414) were found with cefazolin. In outpatients, lower rates of nephrotoxicity (Peto OR, 0.372; 95% CI, 0.192 to 0.722), hepatotoxicity (Peto OR, 0.313; 95% CI, 0.156 to 0.627), and hypersensitivity reactions (Peto OR, 0.372; 95% CI, 0.201 to 0.687) were observed with cefazolin. Compared to antistaphylococcal penicillins, cefazolin was associated with significant reductions in nephrotoxicity and hepatotoxicity in hospitalized patients and outpatients. Additionally, cefazolin was associated with lower likelihoods of discontinuation due to side effects in hospitalized patients and hypersensitivity reactions in outpatients. Cefazolin should be considered a first-line option for patients with MSSA infections for which efficacy is presumed to be similar to that of antistaphylococcal penicillin therapy.\n          <\/jats:p>","DOI":"10.1128\/aac.01816-17","type":"journal-article","created":{"date-parts":[[2018,2,1]],"date-time":"2018-02-01T14:33:55Z","timestamp":1517495635000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":55,"title":["Systematic Review and Meta-analysis of the Safety of Antistaphylococcal Penicillins Compared to Cefazolin"],"prefix":"10.1128","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8355-8637","authenticated-orcid":false,"given":"Khalid","family":"Eljaaly","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia"},{"name":"Department of Pharmacy Practice and Science, University of Arizona, Tucson, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samah","family":"Alshehri","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia"},{"name":"Department of Pharmacy Practice and Science, University of Arizona, Tucson, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian L.","family":"Erstad","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice and Science, University of Arizona, Tucson, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1086\/599376"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000296"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciq146"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1977.03270330059022"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/128.Supplement_2.S386"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1086\/379021"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1086\/430833"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00317-09"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00052-12"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.36.2.440"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/1060028014527820"},{"key":"e_1_3_3_13_2","volume-title":"Abstr IDWeek 2016","author":"Burrelli CC","year":"2016","unstructured":"Burrelli CC, Snyder GM, Gold HS, McCoy C, Mahoney MV, Hirsch EB. 2016. Treatment outcomes with nafcillin versus cefazolin for methicillin-susceptible Staphylococcus aureus bloodstream infections, abstr 1071. Abstr IDWeek 2016, San Diego, CA."},{"key":"e_1_3_3_14_2","volume-title":"cefazolin for complicated methicillin susceptible Staphylococcus aureus (MSSA) infections, abstr 407","author":"Chan L","year":"2016","unstructured":"Chan L, Guarascio AJ, Como J, Chan-Tompkins NH. 2016. Retrospective analysis of adverse events (AEs) between nafcillin vs. cefazolin for complicated methicillin susceptible Staphylococcus aureus (MSSA) infections, abstr 407. Abstr ASM Microbe 2016, Boston, MA."},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40121-017-0148-z"},{"key":"e_1_3_3_16_2","volume-title":"Abstr IDWeek 2016","author":"Hoffmann W","year":"2016","unstructured":"Hoffmann W, Christensen C, Cohen SH. 2016. Outcomes and tolerability of nafcillin versus cefazolin for systemic methicillin-susceptible Staphylococcus aureus (MSSA) infections, abstr 1074. Abstr IDWeek 2016, San Diego, CA."},{"key":"e_1_3_3_17_2","volume-title":"Abstr 55th Intersci Conf Antimicrob Agents Chemother","author":"Monogue ML","year":"2015","unstructured":"Monogue ML, Ortwine JK, Wei W, Bhavan K. 2015. Nafcillin versus cefazolin for the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia, abstr S-912. Abstr 55th Intersci Conf Antimicrob Agents Chemother, San Francisco, CA."},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00485-11"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02800-14"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11096-014-9999-5"},{"key":"e_1_3_3_21_2","volume-title":"Abstr IDWeek 2016","author":"Rutter WC","year":"2016","unstructured":"Rutter WC, Burgess DS. 2016. Nephrotoxicity and clinical outcomes in patients treated with nafcillin or cefazolin, abstr 302. Abstr IDWeek 2016, San Diego, CA."},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.04677-14"},{"key":"e_1_3_3_23_2","volume-title":"Abstr IDWeek 2016","author":"Vu BN","year":"2016","unstructured":"Vu BN, Guo Y, Williamson JE, Chung P. 2016. Evaluation of outcomes in patients treated with antistaphylococcal penicillins versus cephalosporins in methicillin-susceptible Staphylococcus aureus bacteremia, abstr 1076. 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The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomized studies in metaanalyses. 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