Discontinuation Of Ceftriaxone Research Articles

Case of Ceftriaxone-Induced Immune Hemolytic Anemia in an Outpatient Parenteral Antimicrobial Therapy (OPAT) Unit

Background: Ceftriaxone is a commonly used antimicrobial agent for the treatment of various infections. It is frequently administered once daily and is an attractive option for use in both in- and out-patient settings. Ceftriaxone-induced immune hemolytic anemia, while rare, can potentially cause severe and even fatal complications if not identified and managed early. Case Presentation: We present the case of a 59-year-old Korean female with hypertension, hyperlipidemia, diabetes, and no known prior allergies, who was being treated for pyelonephritis in our outpatient parenteral antimicrobial therapy (OPAT) infusion unit with ceftriaxone. A few days following antibiotic exposure she was admitted to the hospital and her laboratory values were most consistent with hemolysis. All values normalized following discontinuation of ceftriaxone and initiation of ertapenem. Conclusion: This case describes the clinical course, alternative diagnosis as well as the severity of ceftriaxone induced immune hemolytic anemia. While a rare phenomenon, it can be potentially fatal. Furthermore, it validates the importance of prompt identification and withdrawal of the offending agent may limit the progression of this disease, especially in the outpatient setting, where patients are not as closely monitored.

セフトリアキソン中止後長期残存した偽胆石による急性胆囊炎・胆管炎の1例

セフトリアキソン中止後長期残存した偽胆石による急性胆囊炎・胆管炎の1例

6. Ceftriaxone and nonconvulsive status epilepticus (NCSE)

Purpose Ceftriaxone related nonconvulsive status epilepticus is least suspected and unusual complication especially patients with renal insufficiency (Pre admission Creatinine 140 microMol/L). Methods We reviewed the clinical and electroencephalographic (EEG) characteristics of a patient presented with delirium due to UTI and renal failure in whom developed alteration of consciousness without convulsions associated with continuous epileptiform EEG activity while being treated with ceftriaxone. Results and conclusion Patient was given Ceftriaxone as treatment for UTI and treatment for electrolyte imbalance. Patient started having decreased responsiveness and altered level of consciousness. The EEG showed continuous or intermittent bursts of generalized, high-voltage, 1–2 Hz sharp wave activity or sharp and slow wave activity that resembled triphasic waves but completely differentiated from triphasic waves. It was not possible to obtain EEG few days after ceftriaxone discontinuation and level of consciousness improved and patient transferred to nursing home with continue AED (dilantin). Epoch 1 is EEG after first dose of ceftriaxone and Epoch 2 is 2nd day after discontinuation of ceftriaxone. It is usually not correlated with the use of ceftriaxone and it is hard to speculate. After evaluating all possible common causes, only thing correlated with this patient was ceftriaxone. Also continued epileptiform activity in presence of dilantin and Lorazepam infusion. The temporal relationship between the start of ceftriaxone therapy and the manifestation of NCSE as well as the withdrawal of ceftriaxone and the improved consciousness within 48 h indicated that ceftriaxone was a causative agent. It has been proposed to be mediated by competitive antagonism of γ-aminobutyric acid (GABA) in brain, which is the principal inhibitory neurotransmitter in the brain, could lead to a low neuronal threshold for neuronal excitation. Cephalosporins can cause nonconvulsive status epilepticus in setting of poor renal elimination. The clinical picture is difficult to differentiate from that of metabolic encephalopathy unless an EEG is obtained. Physicians should be aware of this potentially dangerous complication.

When Nature Meets Nurture: Persistent Yersinia Infection

PRESENTATION When the patient’s symptoms are alleviated, it might seem that the causative infection has cleared. But that was not the case for a 62-year-old man with type 2 diabetes who presented with a 1-week history of constipation, lower abdominal cramping, rectal pressure, and hematochezia. In the emergency department, laboratory testing detected leukocytosis with a white blood cell count of 19 x 10 cells/mm and an elevated neutrophil count. Computed tomography (CT) of the patient’s abdomen and pelvis demonstrated marked inflammation of the rectal wall. He was admitted and underwent colonoscopy, which confirmed the presence of proctitis but was otherwise normal. Four days after admission, his stool culture grew pan-sensitive Yersinia enterocolitica. A diagnosis of Yersinia proctitis was made. Simple hepatic cysts seen on CT were felt to be incidental. The patient was prescribed a 5-day course of oral ciprofloxacin. He returned home and had complete symptom resolution. However, 3 weeks after completing treatment, he experienced gradual onset of severe pain that began in the right upper quadrant of the abdomen and radiated to his back and right shoulder. This was accompanied by malaise, intermittent fevers, and anorexia. He reported a 21-pound unintentional weight loss over the preceding 2 months. One month after discharge, he returned to the emergency department.

Acute generalized exanthematous pustulosis after ceftriaxone use resembling sepsis

Acute generalized exanthematous pustulosis is an uncommon disorder, characterized by the acute onset of multiple pruritic, small, nonfollicular, sterile, superficial pustules over erythematous and edematous skin. It is frequently caused by medications, mainly antibiotics, and particularly beta-lactams. It is a rare condition that is not well known in infectious disease practice. We report a case of ceftriaxone-induced acute generalized exanthematous pustulosis that presented with the appearance of sepsis. After discontinuation of ceftriaxone, the findings were improved.

Ceftriaxone‐induced acute hemolytic anemia

A 7-year-old Caribbean-American boy with a 5-month history of hemophagocytic lymphohistocytosis and previous ceftriaxone exposure presented with fever. He was empirically given amikacin and ceftriaxone after 1:00 PM on Day 1 and acutely developed back and abdominal pain, vomiting, hematuria, and hypotension. Both plasma (see figure, top panel) and urine showed hemolysis. The peripheral blood smear showed diffuse agglutination of RBCs without schistocytes (see figure, lower left). Serum LDH was elevated (1787 U/L); urine was negative for myoglobin. The patient's Hb dropped from 11.7 to 4.4 g/dL in 32 hours. The symptoms, hemolysis, and agglutination resolved (see figure, lower right) with discontinuation of ceftriaxone and two double-volume whole blood exchange transfusions. Immunohematology studies demonstrated a positive DAT due to C3 only, and serologic drug studies were positive with ceftriaxone, but not with amikacin. The RBC agglutination seen on peripheral smear was most likely due to drug/antidrug immune complexes, a theory supported by the finding of IgM ceftriaxone-dependent antibodies (titer = 32) at presentation. The titer decreased to 8 on Day 2 and to 0 by Day 5, suggesting that the antibody was consumed by the RBCs and/or removed by treatment. Drug-induced immune hemolytic anemia (DIHA) due to ceftriaxone-dependent antibodies is uncommon, but well described. The majority of documented cases have occurred in children with a history of exposure to ceftriaxone. Autoagglutination may be a feature of DIHA due to ceftriaxone. It is important to recognize and treat DIHA early, since it can be fatal, but is reversible with treatment.

Elevated Tacrolimus Levels Associated With Intravenous Azithromycin and Ceftriaxone: A Case Report

Drug interactions are a common occurrence with calcineurin inhibitors. We describe the case of a heart transplant recipient who developed increased tacrolimus blood levels after the administration of intravenous azithromycin and ceftriaxone. Tacrolimus levels decreased after the discontinuation of ceftriaxone and switch from intravenous to oral azithromycin. Transplant recipients who receive intravenous azithromycin and/or ceftriaxone concomitantly with tacrolimus therapy should be monitored closely for the duration of the antibiotic administration.

Early biliary pseudolithiasis during ceftriaxone therapy for acute pyelonephritis in children: a prospective study in 34 children.

The prolonged biological half-life of Ceftriaxone, allowing once-daily dosing, has contributed to the large diffusion of this third-generation cephalosporin in children. Ceftriaxone is known to induce reversible precipitates in the gallbladder of adults and children. A prospective study was conducted during 1997 in 34 children admitted for the treatment of acute pyelonephritis. Ceftriaxone (intravenous daily single-dose of 50 mg/kg under 2g/day) was initially used. A first gallbladder sonogram, performed before the first or second injection, was normal in all cases. A second evaluation was performed before the fifth and last injection. On this second evaluation the presence of one (n = 3) or two gallstones was recorded in 5 children (15%) on a sonogram made after 3 (n = 4) or 5 (n = 1) injections. Their median age was 7 years (range 4 months to 11 years). All five children remained symptom-free and the normalization of the sonographic patterns was constant on the last sonogram performed 2 (n = 1), 3 (n = 2) and 5 months (n = 2) after discontinuation of Ceftriaxone. This study confirms the possibility of precocious biliary lithiasis under Ceftriaxone therapy in childhood and their spontaneous dissolution after discontinuation of the drug. They seem unpredictable and independent of the age, sex in a cohort homogeneous for the nature of the infection, modality of a short- and low-dose therapy. Clinicians and radiologists should be aware of this complication as an etiology of a so-called primary cholelithiasis and to prevent anxiety or unnecessary cholecystectomy. The antibacterial and pharmacokinetic benefits of Ceftriaxone outweigh the problem of reversible biliary pseudolithiasis with this drug.