Administration Of Ceftriaxone Research Articles

Differential Effects of Intrahippocampal Administration of Ceftriaxone on Morphine Dependence and Withdrawal Syndrome in Rats.

Glutamate is a key factor in opiate addiction. Glial glutamate transporter-1 (GLT-1) plays a prominent role in glutamate homeostasis. Therefore, different regimens of ceftriaxone as a GLT-1 activator were prescribed to determine whether modulating GLT-1 prevents morphine dependence or withdrawal syndrome. Rats received 10 mg/kg morphine subcutaneously for ten consecutive days. Intrahippocampal ceftriaxone (0.5 μL of 0.5 mM solution) was injected 30 min before morphine administration to assess its effect on dependence process. In the next experiment, after the animals became dependent, ceftriaxone was injected before or after the last morphine administration, and its effect on withdrawal symptoms was evaluated. The reversibility of developed dependence was evaluated in the conditions when morphine and ceftriaxone were administered simultaneously. Two hours after the last morphine injection, naloxone hydrochloride (1.5 mg/kg) was administered, and morphine withdrawal syndrome was recorded for 25 min. Ceftriaxone administration before each morphine injection caused a decrease in the occurrence of withdrawal symptoms. Single dose of ceftriaxone after or before the last dose of morphine did not change the withdrawal symptoms significantly. Ceftriaxone injection for 5 days after becoming dependent could decrease the occurrence of some withdrawal symptoms. Modulation of glutamate with ceftriaxone during morphine injection may be able to prevent dependence. However, a single dose of ceftriaxone after becoming dependent could not decrease withdrawal syndrome. More prolonged administration of ceftriaxone could alleviate the induced dependence.

Comparative prospective cohort study of efficacy and safety according to dosage and administration of ceftriaxone for community-acquired pneumonia

IntroductionLimited prospective evidence has been accumulated regarding the efficacy and safety of ceftriaxone (CTRX) based on differences in dosage and administration of the drug as empiric therapy for community-acquired pneumonia (CAP). This study aimed to compare initial treatment failure, 30-day mortality, and side effects between two groups of hospitalized adult CAP patients: one receiving intravenous CTRX at 1g twice daily (1gq12hr) and the other receiving 2g once daily (2gq24hr). MethodsWe prospectively included patients with CAP admitted to our hospital between October 2010 and December 2018. We analyzed patients initially treated solely with CTRX as either 1gq12hr or 2gq24hr. The primary outcome was initial treatment failure, while secondary outcomes were 30-day mortality and side effects. Inverse probability of treatment weighting (IPTW) analysis was used to minimize biases. ResultsAmong the 457 CAP patients, 186 patients were in the 1gq12hr group and 271 patients were in the 2gq24hr group. After IPTW analysis, no significant differences in initial treatment failure rate (2.43 % vs 4.46 %, p = 0.27) or 30-day mortality rate (2.95 % vs 6.43 %, p = 0.13) were seen between groups. A small but noteworthy tendency was noted in the frequency of side effects between the two groups (1.04 % vs 4.20 %, p = 0.08) following IPTW analysis, even though the difference was not significant. ConclusionsThis study did not find any significant difference between ceftriaxone 1gq12hr and 2gq24hr regarding efficacy or safety in adult patients with CAP. However, CTRX 1gq12hr may represent a safer option in terms of side effects.

Association of Preterm Delivery with Urinary Tract Infection and Preventive Role of Ceftriaxone

Urinary tract infections (UTIs) are the leading cause of maternal morbidity and poor birth outcomes. Pregnancy changes increase UTI risk. A larger bladder, less tone, and a shift in vaginal flora are changes. Eradicating pathogens in the urogenital tract can lower the risk of infection-related preterm labor by stopping the progression of asymptomatic bacteriuria into a more serious infection. Objective: To determine the association of preterm labor with urinary tract infection and the preventive role of ceftriaxone. Methods: A case-control study was conducted at the Department of Obstetrics and Gynecology, Khyber Teaching Hospital, Peshawar, from 14 December 2021 to 10 June 2022. 130 pregnant women who met the selection criteria were recruited from the hospital's post-delivery wards. The participants were then separated into a case group and a control group. Protocols for treating UTIs in female were followed. Ceftriaxone was administered to the group of participants who were UTI-positive. Results: The mean age of female in the case group was 28.88 ± 7.18 and in the controls group was 28.97 ± 6.85 years. The mean gestational age at delivery in cases was 34.28 ± 1.34 weeks and in controls 39.4 ± 1.11 weeks. There was a significant association between preterm labor and urinary tract infection (p= <0.05). Administration of ceftriaxone reduced the risk of preterm labor (p=0.001). Conclusions: It was concluded that there is a significant correlation between UTIs and premature labor and ceftriaxone plays an important role in reducing preterm delivery of UTI patients.

Brain abscess caused by Streptococcus anginosus group: Three case reports

BACKGROUND This case series investigated the clinical manifestations, diagnoses, and treatment of cerebral abscesses caused by Streptococcus anginosus . We retrospectively analyzed the clinical characteristics and outcomes of three cases of cerebral abscesses caused by Streptococcus anginosus and conducted a comprehensive review of relevant literature. CASE SUMMARY Case 1 presented with a history of left otitis media and exhibited high fever, confusion, and vomiting as primary symptoms. Postoperative pus culture indicated a brain abscess caused by Streptococcus constellatus infection. Case 2 experienced dizziness for two days as the primary symptom. Postoperative pus culture suggested an intermediate streptococcal brain abscess. Case 3: Enhanced head magnetic resonance imaging (MRI) and diffusion-weighted imaging revealed occupancy of the left temporal lobe, initially suspected to be a metastatic tumor. However, a postoperative pus culture confirmed the presence of a brain abscess caused by Streptococcus anginosus infection. The three cases presented in this case series were all patients with community-acquired brain abscesses resulting from angina caused by Streptococcus group infection. All three patients demonstrated sensitivity to penicillin, ceftriaxone, vancomycin, linezolid, chloramphenicol, and levofloxacin. Successful treatment was achieved through stereotaxic puncture, drainage, and ceftriaxone administration with a six -week course of antibiotics. CONCLUSION Preoperative enhanced head MRI plays a critical role in distinguishing brain tumors from abscesses. Selecting the correct early diagnostic methods for brain abscesses and providing timely intervention are very important. This case series was in accordance with the CARE guidelines.

Ceftriaxone reverses diet-induced deficits in goal-directed control.

Obesity is associated with numerous health risks and ever-increasing rates are a significant global concern. However, despite weight loss attempts many people have difficulty maintaining weight loss. Previous studies in animals have shown that chronic access to an obesogenic diet can disrupt goal-directed behavior, impairing the ability of animals to flexibly adjust food-seeking behavior following changes in the value of earned outcomes. Changes in behavioral control have been linked to disruption of glutamate transmission in the dorsal medial striatum (DMS), a region critical for the acquisition and expression of goal-directed behavior. The goal of this study was to test whether ceftriaxone, a beta-lactam antibiotic shown elsewhere to upregulate the expression of the glutamate transporter GLT-1, would improve goal-directed control following long-term exposure to an obesogenic diet. Male and female rats were given access to either standard chow or chow plus sweetened condensed milk (SCM) for 6 weeks. Access to SCM was ended and rats received daily injections of either ceftriaxone or saline for 6 days. Rats were then trained to press a lever to earn a novel food reward and, finally, were assessed for sensitivity to outcome devaluation. Histological analyses examined changes to GLT-1 protein levels and morphological changes to astrocytes, within the DMS. We found that ceftriaxone robustly restored goal-directed behavior in animals following long-term exposure to SCM. While we did not observe changes in protein levels of GLT-1 in the DMS, we observed that SCM induced changes in the morphology of astrocytes in the DMS, and that ceftriaxone mitigated these changes. These results demonstrate that long-term access to a SCM diet impairs goal-directed behavior while also altering the morphology of astrocytes in the DMS. Furthermore, these results suggest that ceftriaxone administration can reverse the impairment of goal-directed behavior potentially through its actions on astrocytes in decision-making circuitry.

Could ceftriaxone be a viable alternative to penicillin for the treatment of ocular syphilis?

This study was conducted to compare the effectiveness of ceftriaxone with that of aqueous crystalline penicillin G in treating ocular syphilis. We conducted a retrospective study from 2010 to 2021. Syphilis patients were administered either ceftriaxone (2 g intravenously daily for 14 days) or aqueous crystalline penicillin G [4 million units (MU) intravenously every 4 h for 14 days] as therapeutic interventions. Subsequently, we utilized these two groups to assess the serological results, cerebrospinal fluid analysis, and visual acuity at time intervals spanning 3 to 6 months post-treatment. A total of 205 patients were included, with 34 assigned to the ceftriaxone group and 171 to the penicillin group. The median age of patients was 56 years, with an interquartile range of 49-62 years, and 137 of them (66.8%) were male. Between 3 and 6 months after treatment, 13 patients (38.2%) in the ceftriaxone group and 82 patients (48.0%) in the penicillin group demonstrated effective treatment based on the clinical and laboratory parameters. The crude odds ratio (OR) was 0.672 (95% confidence interval [CI]: 0.316-1.428, P = 0.301), indicating no significant difference in effectiveness between the two groups. Thirty patients (17.5%) in the penicillin group and six patients (17.6%) in the ceftriaxone group did not experience successful outcomes. Notably, no serious adverse effects were reported in both the groups. There was no significant difference in the effectiveness of ceftriaxone and aqueous crystalline penicillin G in treating ocular syphilis. The administration of ceftriaxone without requiring hospitalization presents a convenient and safe alternative treatment option for ocular syphilis.

33. Ceftriaxone Administration for Concomitant Infection During Alcohol Withdrawal is Associated With Lower Total Benzodiazepine Dose

33. Ceftriaxone Administration for Concomitant Infection During Alcohol Withdrawal is Associated With Lower Total Benzodiazepine Dose

Cost-Consequence Analysis of Levofloxacin Compared to Ceftriaxone in Community-Acquired Pneumonia of Adult Inpatients at X Hospital Surakarta

Background: Community-acquired pneumonia is still a significant cost-burden disease in healthcare facilities. Pharmacoeconomic analysis using the cost-consequence analysis (CCA) method of ceftriaxone compared to levofloxacin as a first-line empirical antibiotic has never been carried out. Objective: to model the clinical and economic impact of administering ceftriaxone as a first-line empirical antibiotic compared to its comparator levofloxacin for community-acquired pneumonia therapy in hospitalized adult inpatients from the perspective of healthcare facilities. Methods: This research is a retrospective observational study that collects medical records and patient billing data in X Hospital Surakarta from January to December 2022 period. The study was conducted from June to July 2023. Subjects were adult inpatients aged ≥ 18 years with community-acquired pneumonia and were given levofloxacin or ceftriaxone as first-line empiric antibiotics. The data taken included patient profile, antibiotic effectiveness and direct medical costs. Cost-consequence analysis (CCA) was used to compare levofloxacin to ceftriaxone to assess their impact on length of stay, antibiotic effectiveness, and direct medical costs based on a healthcare perspective. Results: The antibiotic effectiveness for levofloxacin was 75.00%, and ceftriaxone was 93.33%. The average length of stay for levofloxacin was 3.39 days, and ceftriaxone was 3.00 days. The total direct medical costs for levofloxacin were IDR 2,056,799, and ceftriaxone was IDR 1,969,627. Conclusion: The administration of ceftriaxone to levofloxacin as a first-line empirical antibiotic for community-acquired pneumonia in hospitalized adult patients had the consequence of increasing antibiotic effectiveness, reducing the length of stay and saving total direct medical costs by IDR 87,172.

Safety of subcutaneous versus intravenous ceftriaxone administration in older patients: A retrospective study.

Antibiotics play a central role in infection management. In older patients, antibiotics are frequently administered subcutaneously. Ceftriaxone pharmacokinetics after subcutaneous administration is well documented, but little data are available on its safety. We compared the occurrence of adverse events associated with ceftriaxone administered subcutaneously versus intravenously in ≥75-year-old patients. We used data from a single-center, retrospective, clinical-administrative database to compare the occurrence of adverse events at day 14 and outcome at day 21 in older patients who received ceftriaxone via the subcutaneous route or the intravenous route at Rennes University Hospital, France, from May 2020 to February 2023. The subcutaneous and intravenous groups included 402 and 3387 patients, respectively. Patients in the subcutaneous group were older and more likely to receive palliative care. At least one adverse event was reported for 18% and 40% of patients in the subcutaneous and intravenous group, respectively (RR = 2.21). Mortality at day 21 was higher in the subcutaneous route group, which could be linked to between-group differences in clinical and demographic features. In ≥75-year-old patients, ceftriaxone administered by the subcutaneous route is associated with less-adverse events than by the intravenous route. The subcutaneous route, which is easier to use, has a place in infection management in geriatric settings.

Drug-induced Stevens-Johnson syndrome in Post traumatic facial injury.

Stevens-Johnson syndrome is a severe adverse drug reaction affecting the skin and mucous membrane. The causes include Sulfonamides, Anticonvulsants, etc. A patient developed ulcerations in the lips and oral cavity with difficulty in swallowing and rashes over the back, abdomen, and genitalia following administration of injection ceftriaxone 1 g intravenous (IV) b.i.d, injection pantoprazole 40 mg IV b.i.d, tablet aceclofenac + paracetamol 325 mg b.i.d, tablet cetirizine 10 mg b.i.d, chlorhexidine mouth wash, and injection metronidazole 500 mg IV t.i.d for the treatment of traumatic facial injury after 4 days of treatment. Injection ceftriaxone and tablet aceclofenac + paracetamol were suspected as the cause of this reaction. The two drugs were stopped. The patient was treated with corticosteroids, other antimicrobials, and oral topical anesthetics. Health-care providers should be careful about the possible adverse drug reactions even to commonly used drugs.

Effect of Intravenous Push and Piggyback Administration of Ceftriaxone on Mortality in Sepsis

BackgroundThere is a lack of evidence-based guidelines for the administration methods of ceftriaxone in emergency departments (EDs), resulting in the reliance on individual institutional protocols for decision-making. ObjectiveThis study was performed to compare the effects of administering ceftriaxone via intravenous push (IVP) and intravenous piggyback (IVPB) on 28-day mortality in patients with sepsis. MethodsThis was a retrospective study of patients aged 18 years or older with sepsis or septic shock who visited an ED and were treated with ceftriaxone as an initial antibiotic between March 2010 and February 2019. Patients were divided into the IVP group and the IVPB group based on the administration method. The primary outcome was 28-day mortality, and multivariable Cox proportional hazards regression analysis was performed to evaluate the relationship between antibiotic administration methods and 28-day mortality. ResultsDuring the study period, a total of 939 patients were included in the final analysis, and the overall mortality rate was 12.2%. The antibiotic administration time was significantly lower in the IVP group than in the IVPB group, and the rates of antibiotic administration within 1 h and within 3 h were higher in the IVP group than in the IVPB group (p < 0.05). However, there was no significant difference in 28-day mortality between the two groups (hazard ratio 1.07, 95% confidence interval 0.69–1.65). ConclusionsIVP administration of ceftriaxone reduced the time of antibiotic administration compared with IVPB, but there was no difference in 28-day mortality.

Β-Lactam Antibiotic Ceftriaxone As a Potential Therapeutic Intervention for Chronic Pain in Sickle Cell Disease

Sickle cell disease (SCD) features the presence of complex physiologic changes beyond a simple vasculopathy. Among its most debilitating neurological complications, chronic pain remains a challenging condition with limited effective treatments. Patients with SCD suffer tremendous pain every day. β-Lactam antibiotics have been shown to offer neuroprotection by promoting glutamate transporter GLT1 expression in the nervous system. This study aimed to investigate the effect of ceftriaxone, a prototype beta-lactam antibiotic, on chronic pain in SCD. In a humanized mouse model of SCD, spontaneous ongoing pain as well as evoked hypersensitivity to mechanical and thermal stimuli were present in mice carrying human sickle hemoglobin, but not non-sickle control littermates. Notably, prominent activation of astrocytes was observed in the spinal cord dorsal horn region in the mice with SCD. As compared with non-sickle littermates, the spinal expression of GLT1 was dramatically decreased in sickle cell mice. Repeated intraperitoneal administration of ceftriaxone effectively attenuated spontaneous pain, mechanical allodynia, and heat hyperalgesia in mice with SCD. We found the pain reversal effect by ceftriaxone (200 mg/kg, i.p., for 7 days) lasted for at least 4 weeks. Correlating with the behavioral manifestations, ceftriaxone significantly deactivated astrocytes and elevated the level of GLT1 in the spinal cord in the mice with SCD. These findings suggest that ceftriaxone alleviates both non-evoke ongoing pain and evoked pain in SCD by up-regulating spinal GLT1 expression, which highlights the possibility of a new clinical strategy to treat chronic pain in SCD. This study sheds light on the role of astrocyte activation in SCD and lays the foundation for the development of a potential new intervention for chronic pain in sickle cell disease.

378 Effect of Intravenous Push and Piggyback Administration of Ceftriaxone on the Mortality in Sepsis

378 Effect of Intravenous Push and Piggyback Administration of Ceftriaxone on the Mortality in Sepsis

44 Ceftriaxone Prescribing Patterns in an Outpatient Hospital Setting: A Quality Improvement Study

Abstract Background Ceftriaxone is a commonly administered antibiotic in paediatric medical day hospitals (MDH) for certain conditions where it may be considered first-line. Its long half-life permits once-daily dosing, thus potentially avoiding inpatient admission. However, administration of ceftriaxone requires intravenous line insertion, daily follow-up, and time spent by the family. There is a perception among healthcare providers in our tertiary hospital that ceftriaxone use is frequently inappropriate in the outpatient setting, and that more narrow-spectrum oral agents could be prescribed instead. Objectives Our primary objective was to evaluate the appropriateness of ceftriaxone use according to centre-specific first-line indications, in children between the ages of 3 months and 18 years in the MDH. Design/Methods Data were collected retrospectively for one winter season (Nov 2, 2019 to Jan 11, 2020) and one summer season (June 2, 2020 to Sept 25, 2020). All patients initially referred by the emergency department (ED) to the MDH were reviewed. Inclusion criteria included children (age 3 months to 18 years) who received ceftriaxone in the MDH or the ED. Patients with pre-existing immunodeficiency were excluded. Appropriateness was assessed according to the empiric antimicrobial guide available at our centre. In cases where ceftriaxone appropriateness was unclear, a detailed chart review was conducted by two parties including a resident and a staff trained in paediatric infectious diseases. Results Among eligible patients referred to the MDH from the ED (n=196), ceftriaxone was inappropriate in 113 cases (57.7%). Inappropriateness was more prevalent in the summer than the winter (76% vs 41.3%, p&amp;lt;0.0001). The most frequent inappropriate indications for ceftriaxone were: cellulitis with a skin portal of entry, including pre-septal cellulitis (54.0%); non-severe pneumonia (11.5%); and acute lymphadenitis (11.5%). Cellulitis was more prevalent in the summer (38.7% vs 16.3%), whereas pneumonia was more prevalent in the winter (20.2% vs 2.2%). Ceftriaxone was almost always initially prescribed in the ED (95.4%), and was continued in 164/187 (87.7%) of first MDH visits. An average of 2.9 doses of ceftriaxone was given per patient. Only one patient was documented to be initially unwell looking in the ED, and 50% were afebrile. Conclusion Ceftriaxone is overused in the MDH at our institution, largely due to skin and soft tissue infections and non-severe pneumonia. Targeted antimicrobial stewardship interventions to reduce ceftriaxone use in both the ED and MDH could improve the patient experience (less broad-spectrum antibiotics, less invasive procedures) and the efficient use of the MDH.

Risk Factors for Colonization With Extended-Spectrum Cephalosporin-Resistant and Carbapenem-Resistant Enterobacterales Among Hospitalized Patients in Kenya: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study.

The spread of extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE) represents a significant global public health threat. We identified putative risk factors for ESCrE and CRE colonization among patients in 1 urban and 3 rural hospitals in Kenya. During a January 2019 and March 2020 cross-sectional study, stool samples were collected from randomized inpatients and tested for ESCrE and CRE. The Vitek2 instrument was used for isolate confirmation and antibiotic susceptibility testing, and least absolute shrinkage and selection operator (LASSO) regression models were used to identify colonization risk factors while varying antibiotic use measures. Most (76%) of the 840 enrolled participants received ≥1 antibiotic in the 14 days preceding their enrollment, primarily ceftriaxone (46%), metronidazole (28%), or benzylpenicillin-gentamycin (23%). For LASSO models that included ceftriaxone administration, ESCrE colonization odds were higher among patients hospitalized for ≥3 days (odds ratio, 2.32 [95% confidence interval, 1.6-3.37]; P < .001), intubated patients (1.73 [1.03-2.91]; P = .009), and persons living with human immunodeficiency virus (1.70 [1.03-2.8]; P = .029). CRE colonization odds were higher among patients receiving ceftriaxone (odds ratio, 2.23 [95% confidence interval, 1.14-4.38]; P = .025) and for every additional day of antibiotic use (1.08 [1.03-1.13]; P = .002). While CRE colonization was strongly associated with ceftriaxone use and duration of antibiotic use, the odds of ESCrE colonization increased with exposure to the hospital setting and invasive medical devices, which may reflect nosocomial transmission. These data suggest several areas where hospitals can intervene to prevent colonization among hospitalized patients, both through robust infection prevention and control practices and antibiotic stewardship programs.

Validating a novel three-times-weekly post-hemodialysis ceftriaxone regimen in infected Indigenous Australian patients-a population pharmacokinetic study.

To describe the total and unbound population pharmacokinetics of a 2 g three-times-weekly post-dialysis ceftriaxone regimen in Indigenous Australian patients requiring hemodialysis. A pharmacokinetic study was carried out in the dialysis unit of a remote Australian hospital. Adult Indigenous patients on intermittent hemodialysis (using a high-flux dialyzer) and treated with a 2 g three-times-weekly ceftriaxone regimen were recruited. Plasma samples were serially collected over two dosing intervals and assayed using validated methodology. Population pharmacokinetic analysis and Monte Carlo simulations were performed using Pmetrics in R. The probability of pharmacokinetic/pharmacodynamic target attainment (unbound trough concentrations ≥1 mg/L) and toxicity [trough concentrations (total) ≥100 mg/L] were simulated for various dosing strategies. Total and unbound concentrations were measured in 122 plasma samples collected from 16 patients (13 female) with median age 57 years. A two-compartment model including protein-binding adequately described the data, with serum bilirubin concentrations associated (inversely) with ceftriaxone clearance. The 2 g three-times-weekly regimen achieved 98% probability to maintain unbound ceftriaxone concentrations ≥1 mg/L for a serum bilirubin of 5 µmol/L. Incremental accumulation of ceftriaxone was observed in those with bilirubin concentrations >5 µmol/L. Three-times-weekly regimens were less probable to achieve toxic exposures compared with once-daily regimens. Ceftriaxone clearance was increased by >10-fold during dialysis. A novel 2 g three-times-weekly post-dialysis ceftriaxone regimen can be recommended for a bacterial infection with an MIC ≤1 mg/L. A 1 g three-times-weekly post-dialysis regimen is recommended for those with serum bilirubin ≥10 µmol/L. Administration of ceftriaxone during dialysis is not recommended.

Ceftriaxone Administration Associated with Lithiasis in Children: Guilty or Not? A Systematic Review.

Lithiasis is a known side effect of ceftriaxone administration in children. Sex, age, weight, dosage, and duration of intake have been reported as risk factors for the formation of calcification or stones in the bile and urine excretory systems of children who received ceftriaxone. The purpose of this systematic review is to investigate the reported effects of ceftriaxone administration in pediatric patients who were admitted to a hospital due to infection, the likelihood of gallstones, nephroliths, or precipitations in both the biliary and urinary systems, as well as investigate the relationship with their mother's history during pregnancy. Original studies and literature reviews from the PubMed database were included in the study. No time limit related to research or publication was set for the articles. The results were evaluated, aiming to understand the outcomes and identify any predisposing factors relevant to this side effect. Of the 181 found articles, 33 were appropriate for inclusion in the systematic review. The administered dose of ceftriaxone presented variability. Symptoms, such as abdominal pain and vomiting, were associated with ceftriaxone-related lithiasis in many cases. It was noted that most of the results were the outcomes of retrospective observation and not of prospective randomized research. Definitively, more randomized control studies with long-term outcomes are needed to identify the exact association between ceftriaxone and lithiasis in children.

Risk Factors for Ceftriaxone-Associated Pseudolithiasis in Adults

Introduction: Ceftriaxone (CTRX) is known to occasionally cause pseudolithiasis. This condition is often observed in children; however, few studies have reported the incidence and risk factors for CTRX-associated pseudolithiasis. Methods: In this single-center retrospective study, we investigated the incidence of and risk factors for CTRX-associated pseudolithiasis in adults. All patients underwent computed tomography to confirm pseudolithiasis before and after CTRX administration. Results: The study included 523 patients. Pseudolithiasis was detected in 89 patients (17%). Data analysis showed that abdominal area-related biliary diseases at the site of infection (odds ratio [OR] 0.19, 95% confidence interval [CI] 0.064–0.53, p = 0.0017), CTRX administration for >3 days (OR 5.0, 95% CI: 2.5–9.9, p < 0.0001), CTRX dose of 2 mg (OR 5.2, 95% CI: 2.8–9.6, p < 0.0001), fasting period >2 days (OR 3.2, 95% CI: 1.6–6.4, p = 0.0010), and estimated glomerular filtration rate <30 mL/min/1.73 m² (OR 3.4, 95% CI: 1.6–7.5, p = 0.0022) were independent factors for pseudolithiasis. Conclusions: CTRX-associated pseudolithiasis may occur in adults and should be considered in the differential diagnosis in patients who develop abdominal pain or liver enzyme elevation after CTRX administration, particularly in patients with chronic kidney disease, in those who are fasting, in and those who receive high-dose CTRX therapy.

Death from the introduction of Ceftriaxone in the presence of Lidocaine (case report)

In clinical and expert practice, pathological processes such as toxic reactions and anaphylaxis may develop following the introduction of the local anesthetic lidocaine; however, information about the death of children is limited and scattered. The morphological signs of these cases are non-specific, which leads to difficulty in interpreting the results of the study and determining the causes of death.&#x0D; This report described the death of a child following intramuscular administration of ceftriaxone in a 2% lidocaine solution. The results of the primary and commission examination of the corpse and data of repeated pathohistological examinations of a 2-year-old child are presented. The objective expert conclusion about the cause of death following the intramuscular administration of ceftriaxone in a 2% lidocaine solution was toxic effects (overdose) or anaphylactic shock, which requires assessing the sequence of the event and nature of the clinical picture, taking into account the route of drug administration, comprehensive pathohistological and morphological studies, and mandatory forensic chemical determination of the concentration of these drugs in the internal organs and blood.&#x0D; Morphological signs of an allergic reaction can be verified based on pathomorphological data, including changes in the target organs of anaphylaxis and pronounced hemocirculatory disorders. In our opinion, further in-depth study and systematization of available data are needed.

Comparative Analysis of Intravenous Ceftriaxone and Ciprofloxacin for the Treatment of Bacterial Peritonitis in Liver Cirrhosis

Objective: This research aimed to evaluate the relative benefits of intravenous ciprofloxacin and ceftriaxone for the treatment of bacterial peritonitis in cirrhotic liver patients. Study Design: Randomized control trial Place and Duration: Department of Gastroenterology, Shaikh Zayed Hospital Lahore in the period from March, 2022 to August, 2022. Methods: Total 130 patients of bacterial peritonitis in liver cirrhosis were included. Patients were undergone for abdomen ultrasound to diagnose liver cirrhosis. Following the acquisition of written informed consent, participants' personal information (such as age, sex, and residence) was meticulously documented. Patients were equally divided in two groups. Group I received intravenous ceftriaxone 1g 12 hourly among 65 patients and 65 cases of group II received ciprofloxacin 200mg 12 hourly for 6 days. Effectiveness among both groups were assessed. Results: There were 44 (67.7%) males and 21 (32.3%) females in group I and in group II 52 (80%) males and 13 (20%) females. Patients mean age in group I was 39.10±6.29 years and in group II mean age was 41.7±3.50 years. We found that majority of the cases were from urban areas 37 (56.9%) in group I and 39 (60%) cases in group II. Frequency of effectiveness in group I was 49 (75.4%) and in group II efficacy found in 47 (72.3%) cases. Post-treatment complications in group I was 7 (10.8%) and in group II found in 6 (9.2%) cases. Satisfaction rate among patients was almost equal 46 (70.8%) and 45 (62.9%) in group I and II. Conclusion: The findings of this research indicate that the administration of ciprofloxacin intravenously is just as effective as the administration of ceftriaxone intravenously for the treatment of spontaneous bacterial peritonitis in cirrhotic cases.