Introduction
(Article introduction authored by INCA Editorial Team)
Bacterial pneumonia remains a global health challenge with high morbidity and mortality, particularly in vulnerable populations.
Community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) frequently lead to ICU admissions, prolonged hospital stays, and increased healthcare costs.
The rise of antimicrobial resistance, especially from methicillin-resistant Staphylococcus aureus (MRSA), drug-resistant Streptococcus pneumoniae, and extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales, limits the effectiveness of standard treatments.
Ceftobiprole, a fifth-generation cephalosporin, offers broad-spectrum activity against key respiratory pathogens, including MRSA, making it a valuable option for CAP and HAP treatment.
Clinical trials and real-world studies have demonstrated its non-inferiority to standard therapies, high cure rates, and a favorable safety profile, especially in high-risk populations.
Additionally, its role as a carbapenem-sparing agent helps reduce reliance on more toxic antibiotics. This review examines its role in CAP and HAP treatment, focusing on its mechanism, clinical data, and expert perspectives.
Methods
This review summarizes findings from a PubMed search on the use of ceftobiprole in CAP and HAP.
It highlights key features of ceftobiprole, including its mechanism of action and broad spectrum of activity against multiple MDR pathogens.
Clinical data from randomized controlled trials and real-world studies underscore its non-inferiority to standard treatments, with favorable safety profile and high clinical cure rates even in challenging cases.
Expert opinion
Ceftobiprole is a strong option for treating community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP), backed by evidence from preclinical studies, clinical trials, and real-world data.
Its broad-spectrum bactericidal activity makes it effective for empirical treatment, particularly in patients at risk of multidrug-resistant (MDR) pathogens and MRSA infections.
It is also a reliable choice for targeted therapy against S. aureus and other Gram-positive bacteria.
Studies show that ceftobiprole (500 mg every 6 hours for 8 days) is non-inferior to daptomycin in treating bacteremic CAP and HAP caused by S. aureus, including MRSA.
One of ceftobiprole’s key advantages is its ability to be used as monotherapy for polymicrobial infections, potentially replacing multiple antibiotics and reducing reliance on more toxic agents like oxazolidinones or glycopeptides.
However, caution is needed in regions with a high prevalence of ESBL-producing Enterobacterales, where monotherapy may not be sufficient.
Ceftobiprole also has a favorable safety and tolerability profile, with minimal adverse effects and drug interactions.
It is a safer alternative to linezolid, especially for elderly patients at risk of bone marrow suppression and thrombocytopenia, and has a better safety profile than vancomycin, which is linked to nephrotoxicity.
Importantly, it achieves higher lung penetration than vancomycin, enhancing its efficacy in respiratory infections. Another benefit is its minimal impact on gut flora, reducing the risk of Clostridioides difficile infections (CDI).
Unlike many broad-spectrum cephalosporins, ceftobiprole does not promote C. difficile overgrowth, making it a suitable choice for high-risk groups, including elderly patients and transplant recipients. Despite its strengths, ceftobiprole has limitations. It is ineffective against ESBL-producing organisms and MDR P. aeruginosa, requiring careful consideration in high-risk cases. Additionally, many physicians remain unfamiliar with its clinical benefits, and the lack of therapeutic drug monitoring (TDM) limits optimized dosing and wider adoption.
Future research should focus on MRSA bacteremia, potential synergy with daptomycin, and its role in treating Panton-Valentine leukocidin (PVL) producing S. aureus pneumonias, which are rare but severe. These studies could enhance its clinical utility, particularly in critically ill patients.
Conclusion
Ceftobiprole is a safe and effective option for CAP and HAP, with broad-spectrum activity against Gram-positive and Gram-negative bacteria, making it valuable, especially for MRSA infections.
Real-world evidence confirms its non-inferiority to standard treatments, high cure rates, and good safety profile.
Its rapid action, ease of use, and tolerability make it effective as monotherapy or in combination, particularly for elderly patients with complex conditions.
Therapeutic drug monitoring (TDM) is crucial for optimizing dosing, especially in vulnerable populations like the elderly or those with renal impairment.
Source: Gentile, Ivan, et al. “Current role of ceftobiprole in the treatment of hospital-acquired and community-acquired pneumonia: Expert opinion based on literature and real-life experiences.” Expert Review of Anti-infective Therapy just-accepted (2025)
