The environmental impacts and costs of cefotaxime versus ceftriaxone: An example drawn from Paris hospitals

CONTEXT: While health-related carbon emissions are a recognizably increasing concern, the environmental impacts of choosing cefotaxime over ceftriaxone have yet to be assessed on a hospital-wide scale. METHODS: We collected data on antibiotic consumption from 38 university hospitals in 2023. Using the new Carebone® tool, the respective carbon footprints of antibiotics and medical devices were calculated by life cycle assessment. RESULTS: Daily cefotaxime administration (1 g q8h) generates 5.40 kgCO₂eq (±48%), costs €5.5, and produces 274 g of waste, compared with 1.78 kgCO₂eq (±48%), €1.4, and 88 g of waste from ceftriaxone (1 g q24h). Seven hospitals have already implemented policies replacing ceftriaxone with cefotaxime. Similar policies in all 38 hospitals participating in the survey would annually generate 392,543 kgCO₂eq, 20 tons of waste and an additional cost of €440,713. Conversely, replacing cefotaxime with ceftriaxone could save 436,579 kgCO₂e, 22 tons of waste and €490,154 annually. CONCLUSIONS: Policies favoring cefotaxime have environmental and economic costs that should be integrated into antibiotic stewardship recommendations alongside other factors (resistance selection, etc.).