The incidence of adverse reactions to ceftriaxone, which is widely used in China, has gradually increased, with an associated increase in patient fatality. An analysis of the reported data from articles published in China highlights the importance and extent of this growing public health problem.
We identified previously reported cases of adverse effects to ceftriaxone sodium by searching the Chinese Medical Text Database System for reports published between January 2002 and December 2009. The references cited in the articles were examined for additional reports.
A total of 17 articles were identified that cited fatal adverse reactions in 22 cases. Most patients had been treated for upper respiratory tract infection and bronchitis and had no reported history of ceftriaxone allergy. Of the patients, 77% were treated with ceftriaxone without undergoing intradermal testing, and 36% were not offered any information on intradermal testing. Concomitant intravenous medications were prescribed in 7 cases, and an overdose of ceftriaxone sodium was prescribed for two patients. The delay between drug administration and the onset of adverse drug reactions occurred within 30 min in 72.7% of the patients. Of the deaths, 73% occurred on the first day of treatment.
The fatal adverse events associated with ceftriaxone occurred because of inappropriate drug usage, drug overdoses, careless medical personnel, poor medical conditions, and possibly poor drug quality. Although some deaths may be unavoidable, the risks can be minimized by the appropriate administration of ceftriaxone and further consultation with the Chinese medical profession and research.
[Show abstract][Hide abstract] ABSTRACT: The debate as to whether to administer ceftriaxone to neonates is likely to continue. Ceftriaxone has numerous advantages for critically ill pediatric patients. However, it is also known to contribute substantially to the development of biliary pseudolithiasis. Although pediatric patients rarely develop gallbladder disorders, this complication may lead to adverse events in high-risk patients with predisposing factors, particularly in neonates and infants treated with ceftriaxone. In this paper we present an interesting case report of a 28-day-old neonate with spontaneous severe epidural hematoma who developed biliary pseudolithiasis related to the use of ceftriaxone. We also discuss the efficacy of ceftriaxone in neonates and infants. Neonatologists and pediatric intensivists should be aware of the higher risk of co-existence of hyperbilirubinemia and gallbladder disorders while using ceftriaxone in pediatric settings.
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