Administration Of Ceftriaxone Research Articles

Ceftriaxone-associated side effect findings in children’s abdominal ultrasonography

Ceftriaxone is a third-generation cephalosporin, which has a broad spectrum of activity against Gram-negative and Gram-positive bacteria. It can sometimes induce biliary sludge or stone formation because of the interaction with Calcium ions. The aim of this study is to describe the epidemiology of the side effects after the ceftriaxone therapy in hospitalized pediatric patients and to follow up the group of suspected Ceftriaxone-induced adverse effects. Methods: This prospective study was conducted in different Pediatric Services of the University Hospital Center “Mother Theresa”, Tirana, during the period October 2021-March 2022. We studied the ultrasonographic data of 80 patients admitted to these services, who had been on Ceftriaxone therapy. Results: All the females aged from 5-10 years old, and males aged from 6-12 years old, underwent ultrasound examination for other reasons and 21.25% of the cases resulted with pseudolithiasis, while 3.75% with nephrolithiasis. According to the total number of cases, 70.6% of them were asymptomatic. Only 29.4 % of the patients referred right upper quadrant pain and 1 of them showed nausea. The symptoms began from 5th-7th day and last 20 days. The ultrasound imaging performed from 5th- 10th days after Ceftriaxone administration, showed gallbladder sludge and pseudolithiasis in the symptomatic patients, ranged 8-12 mm, and renal microlithiasis <3mm. These patients were followed with ultrasound exam after 1 month. Conclusion: From all pediatric patients treated with Ceftriaxone and followed with ultrasonography, 21.25% resulted with collateral associated gallbladder pseudolithiasis as side effect from ceftriaxone-therapy, found by ultrasonographic evaluation. None of the cases was complicated with gallbladder hydrops, pancreatitis or hydronephrosis. After the Ceftriaxone therapy was discontinued, the condition resolved spontaneously. Key Words: ceftriaxone, gallbladder pseudolithiasis, nephrolithiasis, ultrasound

Ceftriaxone-Induced Acute Hypersensitivity Section Pneumonitis: A Rare Case Report

Hypersensitivity Pneumonitis (HP), also known as extrinsic allergic alveolitis, is a pulmonary disorder characterised by an inflammatory response of the alveoli and small airways due to exposure to a variety of antigens. HP can manifest as acute, subacute, or chronic, depending on the mode of onset and its duration. A broad spectrum of antigens, derived from fungi, bacteria, mycobacteria, birds, chemical sources, and certain drugs such as cyclophosphamide and sulfonamides, has been associated with the development of HP. However, HP developed by Ceftriaxone is an extremely rare occurrence. Here, the authors presented a case of a 26-year-old male who experienced the onset of HP immediately following the administration of injectable Ceftriaxone. He developed a sudden onset of breathlessness and cough, necessitating Mechanical Ventilation (MV) and steroid support. Radiological imaging indicated pneumonitis, and the symptoms gradually resolved after discontinuing Ceftriaxone. Ceftriaxone-induced acute HP represents an unusual clinical presentation. In the present case report, the authors highlighted the possibility of Ceftriaxone as a potential cause of HP, given its capacity for rapid reversal upon its timely removal.

A case report of ceftriaxone-induced cardiopulmonary arrest

and Importance: Ceftriaxone is used frequently in treating infectious diseases. While hypersensitivity skin reactions are common with the use of ceftriaxone, anaphylactic reactions are rare. A 66-year-old female presented to our hospital with complaints of headache and sinus congestion. Vital signs showed hypoxia, and the physical exam was unremarkable. A computed tomography scan of the chest revealed right upper lobe pneumonia, and the patient was started on ceftriaxone and azithromycin. The patient went into asystole 1min after ceftriaxone administration. She did not require cardiopulmonary resuscitative measures as she spontaneously transitioned to normal sinus rhythm. Given the timing of the event immediately after ceftriaxone administration, we determined ceftriaxone was the likely culprit. The patient received alternative treatment for pneumonia and recovered without sequelae. We added ceftriaxone to her allergy list. This case report highlights a rare adverse event associated with ceftriaxone. After an extensive literature search, we found only four other reported cases of cardiopulmonary arrest following ceftriaxone. The exact mechanism for this adverse event has not been fully elucidated. Clinicians should be aware of the potential for ceftriaxone-induced asystole, perform allergy reviews and obtain informed consent before its administration.

Subcutaneously administered antibiotics: a review.

Subcutaneous (SC) administration of antibiotics represents an attractive alternative to the intravenous (IV) route. We performed a systematic electronic search of PubMed and the Cochrane Library for all articles published prior to April 2022, using the key terms and MeSH terms 'subcutaneous', 'antibiotic' and the international non-proprietary name of antibiotics. A total of 30 studies were selected including data on the efficacy and tolerability of antibiotics, and seven studies that were conducted in healthy subjects, for relevant information regarding the safety and tolerability of antibiotics. Comparative studies have shown that efficacy is similar for the SC and IV routes for ceftriaxone, teicoplanin and ertapenem. The SC use of other antibiotics such as ampicillin, ceftazidime, cefepime, piperacillin/tazobactam, metronidazole and fosfomycin has also been described. These results have largely been corroborated by pharmacokinetic/pharmacodynamic analyses, especially for time-dependent antibiotics. Complications of SC treatment are rarely severe, with no reports of bacteraemia or other invasive infection related to this route of administration. Therapeutic drug monitoring has been proposed to adapt the dose and avoid toxicity. The rationale for using SC administration of ceftriaxone, ertapenem and teicoplanin is strong in patients with non-severe infections. It is already commonly practised in some countries, particularly in France. Other antibiotics could be administered subcutaneously, but further studies are needed to validate their use in clinical practice. Further research is needed to safely generalize and optimize this route of administration whenever possible. This would reduce the risk of catheter-related infections and their complications, together with the length of hospital stay.

Emergency Treatment of Submandibular Abscess Spreading to Buccal and Submental Spaces in Uncontrolled Diabetic Patients: A Case Study

Emergency Treatment of Submandibular Abscess Spreading to Buccal and Submental Spaces in Uncontrolled Diabetic Patients: A Case Study Cahyono Yudianto1*, Endang Sjamsudin2, Winarno Priyanto3, Agus Nurwiadh4, 1Resident of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universitas Padjadjaran/ RSUP Dr. Hasan Sadikin, Bandung, Indonesia 2,3,4Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universitas Padjadjaran/ RSUP Dr. Hasan Sadikin, Bandung, Indonesia *Email correspondence: cahyono19001@mail.unpad.ac.id ABSTRACT Introduction: Dental infections can extend to the maxillofacial space causing severe infections such as abscesses. Abscess in the maxillofacial space aggravated by the systemic disease of diabetes mellitus can delay healing and cause further complications. This case report discusses the emergency treatment of a submandibular abscess that extends to the buccal and submental spaces in a patient with diabetes mellitus. Case Report: A 41-year-old female patient came to the Emergency Department of Hasan Sadikin Hospital in Bandung, complaining of swelling on the right cheek. The swelling was felt for seven days which started in the right submandibular area and extended to the right cheek and submental area. The patient had a history of diabetes mellitus for eight years, and on arrival, his current blood sugar was 365 mg/dL. The patient was diagnosed with a submandibular abscess that extends to the right buccal and submental area with uncontrolled diabetes mellitus. Treatment includes a drainage incision, Penrose drain, extraction of the causative tooth, and administration of ceftriaxone, metronidazole, ketorolac, and omeprazole drugs. Conclusion: Submandibular abscess that extends to several maxillofacial spaces is an emergency condition that requires immediate management to prevent the spread of infection to other tissues, which can cause mortality. Keywords: Abscess, Submandible, Buccal, Submental, Diabetes Mellitus

Bilirubin-Displacing Effect of Ceftriaxone in Infants With Unconjugated Hyperbilirubinemia Born at Term

To evaluate the effect of intravenous (IV) ceftriaxone on free bilirubin concentrations in infants with unconjugated hyperbilirubinemia born at term. A prospective study was performed with subjects serving as their own controls. Our inclusion criteria were infants born at term <7days old with sepsis and receiving IV antibiotics for >3days and resolving hyperbilirubinemia with total serum bilirubin levels between 6 and12mg/dL by day 4 of life. Free bilirubin concentrations were measured by the peroxidase method using a UB analyzer and a Zone Fluidics device before (baseline) and 15minutes after (follow-up) IV ceftriaxone administration on postnatal days 4 to 6. Paired measurements of free bilirubin were analyzed using a Student paired t-test or Wilcoxon signed-rank test. In total, 27 infants were studied. The mean free bilirubin (μg/dL) at follow-up was not different from that at baseline when measured by the UB analyzer (P=.78). The mean free bilirubin was significantly lower at follow-up compared with baseline when measured by the Zone Fluidics device (P=.02). The ratio of a free bilirubin with and without ceftriaxone, an index of displacing effect, was 1.02 (95% CI 0.89-1.14) using the UB analyzer and 0.58 (95% CI 0.30-0.86) using the Zone Fluidics device. Ceftriaxone is not associated with a bilirubin-displacing effect in infants with a mild unconjugated hyperbilirubinemia. Home therapy with once-daily intramuscular ceftriaxone may be an alternative option for management of sepsis in asymptomatic infants with a mild unconjugated hyperbilirubinemia born at term.

MICROSTRUCTURAL ORGANIZATION OF PERIODONTIUM UNDER CONDITIONS OF COMPLEX CORRECTION AGAINST THE BACKGROUND OF EXPERIMENTAL TEN-WEEK OPIOID EXPOSURE

In order to develop an adequate scheme of drug correction of periodontal tissue damage on the background of long-term action of the opioid analgesic nalbuphine, experimental studies were performed using the drugs pentoxifylline and ceftriaxone. The study was performed on male rats (24), which were divided into 3 groups. And the group is a control group. Group II – administration to rats of opioid analgesic in increasing doses for 10 weeks, where the initial dose was – 0.212 mg / kg, 9-10 weeks – 0.283 mg / kg. Group III – administration of pentoxifylline (7-10 weeks) and ceftriaxone (9-10 weeks) at a dosage of 2.86 mg against a 10-week opioid effect (from 0.212 to 0.283 mg / kg). For histological examinations, fragments of the dental segment of rats were collected using complex decalcification of the hard tissues of the dental organ. Microscopic studies in animals at 10 weeks of opioid action indicated pronounced inflammatory-dystrophic changes in periodontal tissues, which were manifested by necrotic changes in the mucous membrane of the gums, dystrophic periodontal damage and vascular disorders. Drug correction with pentoxifylline and ceftriaxone on the background of ten weeks of opioid action led to a protective effect on the microstructural organization of periodontal tissues of rats. Although complete restoration of periodontal structures in comparison with the control did not occur, however, the use of etiopathogenetic treatment contributed to a certain stabilization of the inflammatory process. The results showed that the use of pentoxifylline and ceftriaxone prevented the generalized progression of dystrophic changes in the periodontium with long-term opioid action, compared with the detected pathological changes in periodontal tissues in animals under ten weeks of opioid administration without corrective action.

Retrospective Comparison of the Effectiveness and Safety of Ceftriaxone 1 g Twice Daily versus 2 g Once Daily for Treatment of Aspiration Pneumonia.

Although a 2 g once daily administration of ceftriaxone remains the standard dosing regimen for the treatment of aspiration pneumonia, there are no studies to investigate the optimal dosing method. Hence, we retrospectively evaluated the effectiveness and safety of 1 g twice daily versus 2 g once daily administration of ceftriaxone in adult patients with aspiration pneumonia. Patients who received ceftriaxone for the treatment of aspiration pneumonia between 2015 and 2021 were included in this study. Clinical responses, inflammatory markers, and incidence of adverse events after completion of ceftriaxone therapy were investigated. In total, 33 patients received 1 g twice daily (group 1) and 28 received 2 g once daily (group 2) ceftriaxone for the treatment of mild-to-moderate aspiration pneumonia. Compared with that of group 1, group 2 demonstrated significantly improved clinical responses (group 1 vs. group 2, 84.8% vs. 100%, p = 0.0316). Although the safety profile was not significantly different between the two groups, the incidence of choleliths during ceftriaxone therapy in group 1 was higher than that in group 2 (31.3% vs. 9.1%, p = 0.174). Therefore, a 2 g once daily administration of ceftriaxone appeared to be a simple regimen adequate for the treatment of inpatients with mild-to-moderate aspiration pneumonia, which might not be heavily involved by anaerobes.

Ceftriaxone Induced Anaphylaxis Reaction Following Negative Intradermal Skin Tested Patient: A Rare Case Report

Anaphylaxis is a severe life-threatening reaction that may be associated with exposure to a variety of drug classes. β-lactam antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs) are most common classes of drugs causing anaphylaxis. Intradermal skin test (IST) is required in absence of previous history of allergy to antibiotics. In spite of negative intradermal skin testing, our patient had severe anaphylactic reaction after ceftriaxone administration but was managed successfully. This case report reflects the limitations of screening test done preoperatively for the diagnosis of sensitization to ceftriaxone antibiotic drug. Key Messages: Intradermal skin test is mandatory in all patients receiving first exposure of any new antibiotic drug. When a patient is negative after intradermal skin test, the drug should be given as slow intravenous infusion to prevent sudden and dreadful cardiovascular collapse.

A Rare Case Report of Leptospirosis Infection with Jaundice and Acute Kidney Injury Symptoms into the Intensive Care Unit

ABSTRACT&#x0D; INTRODUCTION: Leptospirosis, often known as Weill' disease, is a zoonotic disease caused by spiral-shaped bacteria of the Leptospira genus. This disease is spread by direct or indirect contact with infected animals' urine, such as rats.&#x0D; CASE REPORT: The case was a 49-year-old man, came to Emergency Room DR. Moewardi Hospital Surakarta with symptoms of yellowing of the skin and eyes since 10 days before come to hospital. Patients who complain of fever, vomiting, urine had changed to a brownish yellow like tea and pain all over the body. The patient brought laboratory results of leukocytosis, increase in transaminases, increase in urea and creatinine with clinical symptoms Acute Kidney Injury (AKI) with BUN 122.3 mg/dL and serological examination of leptospira antibodies showed positive results.&#x0D; CONCLUSION: This patient was treated in the Intensive Care Unit room with treatment in the form of cito hemodialysis and administration of the antibiotic ceftriaxone 2gram/12 hours. The patient went home after 5 days of treatment.&#x0D;

Ceftriaxone use for acute otitis media: Associated factors in a large U.S. primary care population

BackgroundClinicians in the authors’ primary care academic practice have anecdotally perceived an increased use of intramuscular (IM) ceftriaxone, particularly for otitis-conjunctivitis in recent years (pre-pandemic). Increasing rates of ceftriaxone administration for acute otitis media (AOM) may be an important marker of antimicrobial resistance. ObjectiveWe aimed to characterize the population of patients who received ceftriaxone for treatment of AOM, testing our hypothesis that patients with concomitant conjunctivitis would have increased rates of ceftriaxone receipt. Design/methodsWe reviewed cases of AOM at a large U.S. primary care practice from August 2017 to July 2019. We determined the association between each of the following variables and ceftriaxone injection using multivariate analysis: age at AOM diagnosis, provider type, insurance (public vs private), season of year, and presence of conjunctivitis. ResultsThere were 6028 AOM episodes in 5195 patients resulting in a total of 7688 patient encounters. Of these episodes, 642 (10.7%) had a concurrent diagnosis of conjunctivitis; 362 (6.0%) ultimately received ceftriaxone. Conjunctivitis was the strongest predictor of treatment with ceftriaxone. The proportion of episodes with conjunctivitis treated with ceftriaxone was 14.5% (93/642) versus 5.0% (269/5386) without conjunctivitis (p < 0.0001). Patients who received ceftriaxone were younger; mean age (SD) for patients receiving ceftriaxone was 14.0 (8.8) months versus 25.0 (23.4) months (p < 0.0001). Conclusion(s)There is a strong correlation between the presence of conjunctivitis and receipt of IM ceftriaxone in this large U.S. academic primary care clinic. Younger age was also associated with ceftriaxone treatment. Further study on emerging resistance patterns and implications for management of AOM in young children is warranted.

Detection of the analgesic effect of ceftriaxone in chicks

Objective: To evaluate the analgesic effect of ceftriaxone when administered alone or in combination with paracetamol and diclofenac sodium in boiler chicks. Methods: This study was conducted in Department of Physiology, Biochemistry and Pharmacology, College of Veterinary Medicine ,University of Mosul , Mosul, Iraq, from November 2021 to February 2022. It was determined using formaldehyde test and the median analgesic effective dose (ED50) for ceftriaxone, paracetamol and diclofenac sodium depending on the method of Dixon. An isobolographic ratio of 0.5:0.5 of the ED50 for each drug at the analgesic level was calculated. Results: The administration of ceftriaxone at doses of (523, 1064 and 1330mg/kg) intramuscularly was led to a significant (p value=0.02) and clear analgesic effect through the disappearance of the right foot lift caused by the injection of formaldehyde, in aadition to significant decrease (p value=0.01) in foot thickness at dose of 1330 mg/kg . Analgesic ED50 of ceftriaxone , paracetamol and diclofenac sodium by Dixon method were 42.6 ,32.6 and 6.26 mg /kg respectively. The intramuscular administrations of drugs in a ratio of 0.5:0.5 result in a significant decrease (p value<0.001) in ED50 values ​ to 6.77, 5.34 and 0.99 mg/kg respectively. The application of the isobolographic analysis revealed the type of interaction between ceftriaxone/paracetamol, ceftriaxone /diclofenac sodium, and the interaction was synergistic when they were given at the ratio 0.5:0.5. Conclusion: The results showed that ceftriaxone exerts its analgesic effect in chicks by reducing the mechanical hyperalgesia resulting from formaldehyde injection in the planter of the right foot and potentiated the analgesic effects of paracetamol and diclofenac sodium through the synergistic interaction. Objective: To evaluate the analgesic effect of ceftriaxone when administered alone or in combination with paracetamol and diclofenac sodium in boiler chicks. Methods: This study was conducted in Department of Physiology, Biochemistry and Pharmacology, College of Veterinary Medicine ,University of Mosul , Mosul, Iraq, from November 2021 to February 2022. It was determined using formaldehyde test and the median analgesic effective dose (ED50) for ceftriaxone, paracetamol and diclofenac sodium depending on the method of Dixon. An isobolographic ratio of 0.5:0.5 of the ED50 for each drug at the analgesic level was calculated. Results: The administration of ceftriaxone at doses of (523, 1064 and 1330mg/kg) intramuscularly was led to a significant (p value=0.02) and clear analgesic effect through the disappearance of the right foot lift caused by the injection of formaldehyde, in aadition to significant decrease (p value=0.01) in foot thickness at dose of 1330 mg/kg . Analgesic ED50 of ceftriaxone , paracetamol and diclofenac sodium by Dixon method were 42.6 ,32.6 and 6.26 mg /kg respectively. The intramuscular administrations of drugs in a ratio of 0.5:0.5 result in a significant decrease (p value<0.001) in ED50 values ​ to 6.77, 5.34 and 0.99 mg/kg respectively. The application of the isobolographic analysis revealed the type of interaction between ceftriaxone/paracetamol, ceftriaxone /diclofenac sodium, and the interaction was synergistic when they were given at the ratio 0.5:0.5. Conclusion: The results showed that ceftriaxone exerts its analgesic effect in chicks by reducing the mechanical hyperalgesia resulting from formaldehyde injection in the planter of the right foot and potentiated the analgesic effects of paracetamol and diclofenac sodium through the synergistic interaction.

Acute necrotizing calculous cholecystitis after treatment with ceftriaxone in an elderly patient: a case report

BackgroundCeftriaxone, a third-generation cephalosporin antibiotic with a long plasma half-life, is widely used to treat various infections. The use of ceftriaxone can sometimes induce biliary sludge or stone formation. Although most cases of ceftriaxone-induced pseudolithiasis are asymptomatic or mild and resolve with discontinuation of the drug, we experienced an elderly case of severe acute necrotizing calculous cholecystitis after administration of ceftriaxone.Case presentationA 72-year-old male patient was admitted to our hospital because of acute diverticulitis in ascending colon. Ceftriaxone was administered at a dose of 2 g/day for 6 days. Although he recovered after therapy, he was readmitted about 2 weeks later because of severe pain with rebound tenderness in the right upper quadrant. An abdominal imaging study revealed stones and sludge in the gallbladder that were not observed before starting ceftriaxone therapy. Therefore, antibiotic treatment with flomoxef 2 g/day was indicated. However, on the fifth day of readmission, the peritoneal irritation symptoms in the right upper quadrant worsened, and elevated inflammatory response and liver dysfunction were observed. Cholecystectomy was performed based on these findings. The resected inflamed gallbladder showed acute necrotizing cholecystitis with sand granular gallstones. A comparative analysis of the infrared spectroscopic pattern of the composition of gallstones collected during surgery with that of the ceftriaxone powder revealed that both have very similar infrared spectroscopic patterns.ConclusionsCeftriaxone-related pseudolithiasis is generally reversible and mainly observed in children. Here, we report a rare case of ceftriaxone-related acute necrotizing cholecystitis in an elderly patient. We confirmed that the stones in the gallbladder are composed of ceftriaxone. The older age, dehydration, fasting, and long-time bed rest during the administration of high-dose ceftriaxone were the potential risk factors for gallstone formation.

Comparison of Frequency of Post Caesarean Wound Infection with Amoxicillin Versus Ceftriaxone

Background: Cesarean delivery is a crucial factor in association with postpartum infection, there is a 5 to 20-timesmuch higher risk of getting an infection in contrast with a vaginal delivery. By not having prophylactic antibiotics, the rates of postpartum endometritis can reach 35 to 40%. This study was conducted to contrast the frequency of postoperative wound infection in patients receiving prophylactic amoxicillin vs. ceftriaxone. Methods: This Randomized Controlled Trial was conducted at the Department of Obstetrics &amp; Gynecology, Ayub Teaching Hospital, Abbottabad, from 1st February 2016 to 31st January 2017. 210 patients undergoing cesarean section were included in this study. All the patients who participated in this study were categorized and further divided into two equal groups. Each group comprised 105 patients each through the process of block randomization. Patients in Group A were administered Amoxicillin 1000 mg and patients in group B were administered ceftriaxone 1000 mg for 48 hours following cesarean section patients were followed up on the 8thpost-op day for removal of stitches and wound examination. Results Wound infection was noted in 17 (8.1%) patients. 13 of which belonged to the Amoxicillin category. There was a statistically huge difference between the two groups regarding postoperative wound infection (p=0.023). Upon stratification of outcome variable with age and parity, the results were found to be statistically insignificant (p &gt; 0.05). Conclusion The incidence of post-operative wound infection is minimal with the administration of ceftriaxone following a cesarean section. Keywords: Amoxicillin, Ceftriaxone, Nosocomial infection, Wound infection, cesarean section.

Rat bite fever in a total knee arthroplasty: an unusual case of periprosthetic joint infection

BackgroundPeriprosthetic joint infection (PJI) is a serious complication of orthopedic arthroplasty surgery. Rat bite fever is a rare infection with Streptobacillus moniliformis (S. moniliformis). Rat bite fever can lead to serious complications such as pyogenic infection of joints, bacteremia, endocarditis and even death. We hereby present the first case of a patient with a total knee arthroplasty, infected with S. moniliformis, successfully treated by surgical debridement, antibiotics and implant retention (DAIR).Case presentationThe patient was a 64-year-old female. S. moniliformis was isolated from blood cultures and an aspirate of the left knee by 16S rRNA gene polymerase chain reaction technique. It was assumed that the S. moniliformis had a systemic origin and secondarily infected the knee due to fever nine days before the onset of symptoms of the knee. The patient was successfully managed with DAIR and intravenous administration of ceftriaxone for six weeks and oral doxycycline for another six weeks.ConclusionsS. moniliformis is a rare pathogen and is difficult to culture. The 16S rRNA sequencing is helpful in the determination of a causative microorganism in the case of a culture-negative PJI. A DAIR procedure in combination with 12 weeks of antibiotics could successfully treat S. moniliformis prosthetic joint infection.

Effectiveness of antimicrobial therapy for community-acquired pneumonia in real clinical practice

Background. Community-acquired pneumonia (CAP) remains one of the most common infectious diseases, occupying an important place in the structure of mortality worldwide.Aim. To evaluate the effectiveness of antimicrobial therapy for community-acquired pneumonia in hospitalized patients in real clinical practice.Materials and methods. A retrospective, observational study was conducted, which included 236 patients hospitalized for community-acquired pneumonia at the Regional Clinical Hospital in Ryazan in 2019. Based on these case histories, an analysis of the effectiveness of the initial empiric antimicrobial therapy was performed.Results. The initial empiric antimicrobial therapy in 73% of cases included administration of ceftriaxone, in 45% of cases – levofloxacin, in 14% of cases – azithromycin. It was found that initial antimicrobial therapy was effective in 58% of patients who did not require replacement for the antibiotic. A need for a change in the treatment regimen was significantly associated with an increase in the length of hospitalization (p &lt; 0.001), heart rate upon admission (p = 0.032), myelocyte count in the complete blood count (p &lt; 0.001), and urea and blood creatinine levels (p = 0.004 and p = 0.044, respectively). The selected antimicrobial therapy regimen was significantly associated with the expected treatment effectiveness (p = 0.039). The choice of levofloxacin in monotherapy or in combination with ceftriaxone was accompanied by a decrease in the relative risk of replacing the antimicrobial, compared with other treatment regimens (odds ratio (OR) = 0.86 (95% confidence interval (CI): 0.55–1.34) and OR = 0.57 (95% CI: 0.37–0.87), respectively).Conclusion. Empiric antimicrobial therapy for community-acquired pneumonia in real clinical practice complies with current recommendations, however, at the same time, its ineffectiveness persists. Respiratory fluoroquinolones are most effective in treating pneumonia in hospitalized patients.

Ampicillin Plus Ceftriaxone Combined Therapy for Enterococcus faecalis Infective Endocarditis in OPAT.

Ampicillin plus ceftriaxone (AC) is a well-recognized inpatient regimen for Enterococcus faecalis infective endocarditis (IE). In this regimen, ceftriaxone is usually administered 2 g every 2 h (AC12). The administration of AC in outpatient parenteral antibiotic treatment (OPAT) programs is challenging because multiple daily doses are required. AC regimens useful for OPAT programs include once-daily high-dose administration of ceftriaxone (AC24) or AC co-diluted and jointly administered in bolus every 4 h (ACjoined). In this retrospective analysis of prospectively collected cases, we aimed to assess the clinical effectivity and safety of three AC regimens for the treatment of E. faecalis IE. Fifty-nine patients were treated with AC combinations (AC12 n = 32, AC24 n = 17, and ACjoined n = 10). Six relapses occurred in the whole cohort: five (29.4%) treated with AC24 regimen and one (10.0%) with ACjoined. Patients were cured in 30 (93.3%), 16 (94.1%), and eight (80.0%) cases in the AC12, AC24 and ACjoined groups, respectively. Unplanned readmission occurred in eight (25.0%), six (35.3%), and two (20.0%) patients in the AC12, AC24 and ACjoined groups, respectively. The outcome of patients with E. faecalis IE treated with AC in OPAT programs relies on an optimization of the delivery of the combination. AC24 exhibit an unexpected rate of failures, however, ACjoined might be an effective alternative which clinical results should corroborate in further studies.

Ceftriaxone-associated Pseudolithiasis in Elderly People: Frequency and Risk Factors.

Objective Ceftriaxone (CTRX) is a widely used antibiotic because of its long plasma half-life and good tissue transmission. Many of the reported studies on CTRX-associated pseudolithiasis were performed in children. Although some studies have been published in adults, there are no studies limited to elderly people. The present study investigated CTRX-associated pseudolithiasis and explored its risk factors in the elderly. Methods We retrospectively reviewed 133 elderly patients (≥65 years old) treated with CTRX. Pseudolithiasis was defined as stones or sludge newly appearing in the gallbladder, as detected by computed tomography after the administration of CTRX. We evaluated the risk factors for pseudolithiasis using multivariate regression and inverse probability of treatment weighting analyses. Results Among the 133 patients, 24 (18%) developed CTRX-associated pseudolithiasis. In a multivariate analysis, the CTRX dose [odds ratio (OR) 4.54, 95% confidence interval (CI) 1.36-15.07, p=0.012] and CTRX treatment duration (OR 2.80, 95% CI 1.06-8.04, p=0.043) were significantly associated with pseudolithiasis formation. The cut-off value of the total CTRX dose associated with pseudolithiasis formation was 19 g. A propensity analysis determined that the frequency of pseudolithiasis was increased in patients treated with >19 g total CTRX compared with those who received ≤19 g in total (OR 4.06, 95% CI 1.45-11.32, p=0.008). Conclusion The incidence rate of CTRX-induced pseudolithiasis is high in elderly people, and the CTRX dose and CTRX treatment duration are significant risk factors for pseudolithiasis. A total dose of >19 g increases the likelihood of pseudolithiasis formation in elderly people treated with CTRX.

542 Ceftriaxone-induced Kounis syndrome in the time of COVID-19

A 53 years old male subject with diabetes mellitus, hypertension, dyslipidaemia, obesity, and history of perianal abscess was admitted to the local hospital for generalized maculopapular rash on his trunk and limbs, which was accompanied by intense itching, sweating, hypotension, and severe chest pain. The rash and the accompanying signs/symptoms appeared 10 min after the administration of ceftriaxone (2 g) as antibiotic therapy for the perianal abscess. The patient had no clinical history for any type of allergy. At the first medical contact, an urgent electrocardiogram was taken showing ST-segment elevation in the anterior–lateral leads. The patient was still then treated with methylprednisolone and adrenalin i.v. as an anaphylactic shock was suspected. Afterwards, the patient was admitted in the emergency department, where he showed flu-like symptoms, chills, and fever. An echo-fast showed left ventricular wall motion abnormalities with hypokinesia of the anterior and posterior wall and moderate mitral regurgitation with normal EF. Laboratory tests showed increased levels of high-sensitivity cTnT (32.8 ng/l; NV < 14), white blood cells (13.74 × 103/μl; NV 5.2–12.4 × 103), IL-6 (10.54 pg/ml; NV < 7), C-reactive protein (PCR) (29.3 mg/l; NV 0–3). As for the cutaneous manifestations, flu-like symptoms, and blood test results (elevation of IL-6 and PCR despite an increase of white cell count) a SARS COV-2 swab was done. As recently noted in several preliminary studies, COVID-19 patients indeed show erythematous rash, and localized or widespread urticaria as initial manifestations in acute severe cases along with the humoural acute-phase response. The latter made it complicated to distinguish viral infection vs. drug administration as the underlying cause of the event. In the meantime, the patient started the treatment for an acute coronary syndrome and acetylsalicylic acid 100 mg, clopidogrel 300 mg orally, and enoxaparin dose subcutaneously were administered. Chest pain disappeared 30 min later and the ECG returned to normal 40 min after drug administration. Subsequently, the swab test result turned to be negative for SARS-CoV-2 and the patient was transferred to our centre for an emergency coronary angiography that revealed proximal subocclusive thrombotic stenosis and middle 70–80% thrombotic stenosis of the left anterior descending (LAD) coronary artery and a 80% thrombotic stenosis of the distal portion of the circumflex. Both vessels’ respective stenoses were treated with PCIs. When considering all together the anamnestic, laboratory, and instrumental/invasive findings, a case of Kounis Syndrome (KS) was suspected. Kounis syndrome (KS) has been indeed defined as cardiovascular symptoms that occur secondary to allergic or hypersensitivity insults mainly elicited by specific medications in male patients. KS involves the following three recognized variants: Type 1: the acute coronary event is secondary to spasm; Type 2: coronary thrombosis is the main culprit, and Type 3: the coronary event occurs secondary to drug-eluting stent thrombosis. Therefore, the patient was finally discharged with the diagnosis of ST-elevated MI likely secondary to a type II KS.

Balloon-compression endoscopic injection sclerotherapy for the treatment of esophageal varices.

Video 1Balloon-compression endoscopic injection sclerotherapy for the treatment of esophageal varices. A 50-year-old man with schistosomiasis-induced liver fibrosis presented with melena and hematemesis. The bleeding stopped after intravenous administration of somatostatin and ceftriaxone for 4 days. Balloon-compression endoscopic injection sclerotherapy (bc-EIS) was performed with the patient under general anesthesia to prevent rebleeding. The novel device for bc-EIS is composed of a syringe, a stopcock, a catheter, and an inflatable balloon. In the majority of patients with cirrhosis, the blood flow from the coronary vein drains into the azygos and hemiazygos venous system through esophageal and para-esophageal varices, and eventually back to the inferior vena cava. With compression of proximal esophageal and para-esophageal varices via an inflated balloon, sclerosant can be retained at the injection site, rather than flowing back to the inferior vena cava. Endoscopy revealed the presence of moderately enlarged, beady esophageal varices with red wale signs in the middle and lower esophagus. An inflatable balloon was fixed to an endoscope at a distance of 3 cm from its distal end. When the end of the endoscope was introduced to the target varices, 20 mL of air was injected into the balloon through a thin catheter, making its outer diameter expand to 3.5 cm. A disposable endoscopic injection needle then entered the base of the variceal columns near the cardia. When blood flowed back into the needle, a mixture of Lauromacrogol and methylene blue was intravariceally administered. Minor bleeding at the injection site was stopped through brief compression with the needle sheath. The second injection was performed following the aforementioned procedure. Follow-up endoscopy at 1 month, 4 months, and 7 months revealed the progression from thrombosed blue varices to complete eradication of esophageal varices. Endoscopic ultrasonography also showed the absence of blood flow in the varices after treatment. To date, bc-EIS has been performed successfully on 28 patients with esophageal varices. Variceal eradication was obtained in 17 patients with 1 session, 10 patients with 2 sessions, and 1 patient with 3 sessions. Two patients showed recurrence of esophageal varices on routine follow-up endoscopy and were re-treated with bc-EIS successfully. There were no severe complications during the follow-up period. With the sclerosant retained at injection sites after balloon compression, bc-EIS enables complete eradication of esophageal varices and lowers the risk of recurrence. The blockade of sclerosant also decreases the incidence of complications related to large-volume injection of sclerosant, such as embolization, ulceration, and perforation. In conclusion, bc-EIS appears to be an effective and safe approach for the treatment of esophaeal varices. Further research is underway to determine its suitability for large-scale clinical application.