Methicillin-resistant Staphylococcus aureus (MRSA) endovascular infections are associated with high mortality. The increasing reports of clinical failure and toxicities associated with first-line vancomycin provide a medical need for alternative therapies. In this narrative review, we analyze studies published from 2017 to 2025 on the efficacy and tolerability of ceftaroline, a β-lactam antibiotic with anti-MRSA activity, for off-label treatment of endovascular infections. Identified publications included 1 randomized controlled trial (RCT), 17 retrospective cohort studies, four case series, and one meta-analysis. Failure rates were similar between ceftaroline, vancomycin, and daptomycin when used as monotherapies. Ceftaroline, used in combination with vancomycin or daptomycin, showed efficacy and tolerability in high-risk MRSA bacteremia cases. Although higher-level evidence is needed to definitively establish ceftaroline as a mainstay treatment of MRSA endovascular infections, the current evidence positions ceftaroline as one of several antibiotic strategies in serious cases of MRSA endovascular infections.
Cosimi et al. (Wed,) studied this question.