ro13-9904 and Anemia--Sickle-Cell

To determine the safety of ceftriaxone in paediatric patients and systematically evaluate the categories and incidences of adverse drug reactions (ADRs) of ceftriaxone in paediatric patients.. We performed a systematic search in Medline, PubMed, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, International Pharmaceutical Abstracts and bibliographies of relevant articles up to December 2018 for all types of studies that assessed the safety of ceftriaxone in paediatric patients aged ≤18 years.. 112 studies met the inclusion criteria involving 5717 paediatric patients who received ceftriaxone and reported 1136 ADRs. The most frequent ADRs reported in prospective studies were gastrointestinal (GI) disorders (37.4 %, 292/780), followed by hepatobiliary disorders (24.6%, 192/780). Serious ADRs leading to withdrawal or discontinuation of ceftriaxone were reported in 86 paediatric patients. Immune haemolytic anaemia (34.9%, 30/86) and biliary pseudolithiasis (26.7%, 23/86) were the two major causes. Haemolytic anaemia following intravenous ceftriaxone led to death in 11 children whose primary disease was sickle cell disease. Almost all biliary pseudolithiasis are reversible. However, the incidence was high affecting one in five paediatric patients (20.7%).. GI ADRs are the most common toxicity of ceftriaxone in paediatric patients. Immune haemolytic anaemia and biliary pseudolithiasis are the most serious ADRs and the major reasons for discontinuation of ceftriaxone. Immune haemolytic anaemia is more likely in children with sickle cell disease and may cause death. Ceftriaxone should be used with caution in children with sickle cell disease.. CRD42017055428.

Topics: Anemia, Hemolytic; Anemia, Sickle Cell; Anti-Bacterial Agents; Ceftriaxone; Diarrhea; Digestive System Diseases; Exanthema; Humans; Nephrolithiasis; Pediatrics; Thrombocytosis; Ureteral Calculi; Urination Disorders

Spondylodiscitis is an unusual diagnosis among children and consequent abscess formation is even rarer. A 6-year-old girl with fever, hip pain, and refusal to walk was evaluated. The neurologic examination was normal. Recurrent joint pain with cold weather, iron for anemia without improvement, and decreased intervertebral spaces raised the use of ceftriaxone, oxacillin, and external immobilization. Hemoglobin sickle cell disease, spondylodiscitis with paravertebral collections, and epidural abscess were documented. She was fully recovered. The treatment was conservative because there was no neurologic deficit. We add to the literature 1 case of spondylodiscitis with epidural abscess that was successfully treated with antibiotics alone.

Topics: Anemia, Sickle Cell; Anti-Bacterial Agents; Ceftriaxone; Child; Discitis; Epidural Abscess; Female; Humans; Lower Extremity; Oxacillin; Pain; Pain Management; Radiography; Remission Induction

Topics: Anemia, Hemolytic; Anemia, Sickle Cell; Bacterial Infections; Ceftriaxone; Cephalosporins; Child; Follow-Up Studies; Humans; Male; Severity of Illness Index

Yersinia enterocolitica sepsis is rarely encountered in patients without an underlying susceptibility and is most frequently reported in iron-overloaded patients. This is thought to be related to the unusual utilization of iron by this microorganism. We report a case of Y. enterocolitica bacteremia in a chronically transfused adolescent with sickle cell anemia. This type of serious infection in sickle cell disease is previously unreported. A description of the case and the relationship between Y. enterocolitica and iron is discussed. A review of the literature is presented.. Y. enterocolitica can cause a severe septicemia, and increased virulence of this organism has been shown to correlate with increased iron burden and/or use of the chelator deferoxamine. It may also occur as a consequence of a contaminated blood transfusion.. We believe our case demonstrates that Y. enterocolitica should be considered a possible pathogen in febrile chronically transfused patients with sickle cell disease. Broad antibiotic coverage should be initiated and deferoxamine discontinued pending results of cultures.

Topics: Adolescent; Anemia, Sickle Cell; Bacteremia; Blood Transfusion; Ceftriaxone; Deferoxamine; Disease Susceptibility; Hemochromatosis; Humans; Male; Yersinia enterocolitica; Yersinia Infections

Children with sickle cell disease are at increased risk for bacterial sepsis and, when febrile, are usually hospitalized for intravenous antibiotic therapy pending results of blood cultures. In this study, we prospectively identified a group of febrile patients with sickle cell disease who were at low risk for sepsis and treated them with outpatient therapy.. Children identified as low risk for sepsis were treated with an initial dose of intravenous ceftriaxone, followed by outpatient therapy with oral cefixime, and were monitored for 14 days after the initial visit. Compliance was assessed by phone calls to parents and by analysis of urine samples.. In 107 eligible febrile episodes (80 patients) over a 21-month period, no patient developed sepsis. One child developed bacteremia 3 days after completing the course of cefixime, and one had splenic sequestration on the fourth study day. Both patients did well. Side effects of cefixime were modest, and overall compliance was excellent (approximately 95%), although urine samples were returned by only 56% of parents.. We conclude that outpatient therapy is safe and effective in febrile patients with sickle cell disease who meet the criteria for a low risk of sepsis.

Topics: Administration, Oral; Adolescent; Anemia, Sickle Cell; Anti-Infective Agents; Bacteremia; Bacterial Infections; Cefixime; Cefotaxime; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Drug Therapy, Combination; Female; Fever; Humans; Infant; Male; Outpatients; Patient Compliance

Because of their susceptibility to pneumococcal sepsis, children with sickle cell disease and fever are usually hospitalized for antibiotic therapy. Outpatient treatment may be a safe and less expensive alternative for selected patients.. After evaluation in the emergency room, children ranging from 6 months to 12 years of age who had sickle hemoglobinopathies and temperatures exceeding 38.5 degrees C were randomly assigned to treatment as either inpatients or outpatients. We excluded from randomization children at higher risk of sepsis (as defined by specific criteria, including temperature above 40 degrees C, white-cell count below 5000 per cubic millimeter or above 30,000 per cubic millimeter, and the presence of pulmonary infiltrates) or with complications of sickle cell disease (such as a hemoglobin level below 5 g per deciliter, dehydration, or severe pain); these children were treated as inpatients. All patients received an initial intravenous dose of ceftriaxone (50 mg per kilogram of body weight). Those treated as outpatients returned 24 hours later for a second dose of ceftriaxone, whereas the in patients were treated as directed by their physicians.. None of the 86 patients (with a total of 98 febrile episodes) in the randomized groups had sepsis, as compared with 6 of the 70 patients (7 of 86 episodes) excluded because of higher risk (P = 0.004). Among the 44 children (50 episodes) assigned to outpatient treatment, there were 11 hospitalizations (22 percent of episodes) within two weeks after treatment (95 percent confidence interval, 12 to 36 percent), whereas after inpatient care only a single patient (2 percent of episodes) was rehospitalized. When the randomized groups were compared, outpatient treatment saved a mean of $1,195 per febrile episode. The median hospital stay was 3 days (range, 1 to 6) for the children randomly assigned to inpatient care and 4 days (range, 1 to 18) for the higher-risk children treated as inpatients (P < 0.001).. With the use of conservative eligibility criteria, at least half the febrile episodes in children with sickle cell disease can be treated safely on an outpatient basis, with substantial reductions in cost.

Topics: Ambulatory Care; Anemia, Sickle Cell; Bacteremia; beta-Thalassemia; Ceftriaxone; Child; Child, Preschool; Female; Hemoglobin SC Disease; Hospitalization; Humans; Infant; Male; Pilot Projects; Prospective Studies; Random Allocation

Children with sickle cell disease have a greatly increased potential for developing rapid and at times fatal sepsis from Streptococcus pneumoniae. Hospitalization and parenteral antibiotic treatment in all febrile children with sickle cell disease have thus become the standard of care at most sickle cell centers. As an alternative approach, we managed selected febrile children with sickle cell disease on an ambulatory basis with parenteral ceftriaxone to determine its safety and effectiveness in preventing sepsis and reducing the number of days of hospitalization. Twenty of 40 children who presented with significant fever met the study criteria and received ceftriaxone on an ambulatory basis. Three were subsequently hospitalized. Compared with a previous year, when all febrile children were admitted, ceftriaxone use reduced the days of hospitalization from 214 (6.3 +/- 1.6 days/patient) to 111 days (2.8 +/- 0.7 days/patient). The empiric use of ceftriaxone appears safe and effective, but it requires an expanded study over an extended period.

Topics: Adolescent; Adult; Ambulatory Care; Anemia, Sickle Cell; Ceftriaxone; Child; Child, Preschool; Fever; Humans; Infant; Pilot Projects

Topics: Anemia, Sickle Cell; Anti-Bacterial Agents; beta-Lactams; Ceftriaxone; Chronic Pain; Humans

To this day, there are limited data about the effects and management of coronavirus disease infection in pediatric patients with sickle cell disease. We present the management and successful clinical course of an 8-year-old female with homozygous sickle cell disease (SS) and severe acute chest syndrome secondary to coronavirus disease 2019 infection, complicated by cortical vein thrombosis.

Topics: Anemia, Sickle Cell; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Child; COVID-19; Erythrocyte Transfusion; Female; Humans; Intensive Care Units; Systemic Inflammatory Response Syndrome

To describe a case of ceftriaxone-induced immune hemolytic anemia (CIIHA) in a 6 year-old boy with sickle cell disease (SCD) and perform a systematic literature review to delineate the clinical and laboratory features of this condition.. EMBASE (1947-January 2014), MEDLINE (1946-January 2014), and databases from the US Food and Drug Administration and Health Canada were searched, using anemia, hemolytic anemia, hemolysis, and ceftriaxone as search terms. Additional references were identified from a review of literature citations.. All case reports and observational studies describing clinical and laboratory features of CIIHA were included.. A total of 37 eligible reports of CIIHA were identified, including our index case, and 70% were children. Mortality was 30% in all age groups and 64% in children. The majority of patients had underlying conditions (70%), of which SCD was most commonly reported. Previous ceftriaxone exposure was reported in 65%. Common features included elevated lactate dehydrogenase (70%); early, new-onset hemoglobinuria (59%); acute renal failure (46%); positive direct antibody testing (70%); and anticeftriaxone antibodies (68%). Also, 32% had a preceding, unrecognized, hemolytic episode associated with ceftriaxone.. Given the common use of ceftriaxone worldwide, knowledge of CIIHA, which often goes undiagnosed until late in the course, is essential for clinicians. Based on the findings of this review, we suggest obtaining past history of ceftriaxone exposures and screening for new-onset hemoglobinuria during ceftriaxone therapy in selected patients as potential methods for early diagnosis of this rare but potentially fatal condition.

Topics: Anemia, Hemolytic, Autoimmune; Anemia, Sickle Cell; Anti-Bacterial Agents; Autoantibodies; Ceftriaxone; Child; Humans; Male; Respiratory Tract Infections

Topics: Anemia, Sickle Cell; Anti-Bacterial Agents; Ceftriaxone; Child; Humans; Male; Multiple Organ Failure; Saudi Arabia

Multi-organ failure syndrome (MOFS) is a rare life threatening complication of sickle cell disease. It is precipitated by severe vaso-occlusive episodes. We report a Saudi boy with sickle cell anemia, who developed acute MOFS following anaphylaxis to ceftriaxone administration. He had a dramatic recovery after red blood cell exchange transfusion and peritoneal dialysis.

Topics: Anemia, Sickle Cell; Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Humans; Male; Multiple Organ Failure; Saudi Arabia

Ceftriaxone-induced hemolytic anemia is a rare and often fatal phenomenon. We report here the case of a 6-year-old female with sickle cell disease who survived a brisk and profound hemolytic reaction, resulting in hemoglobin of 0.4 g/dL, after ceftriaxone infusion. Ongoing hemolysis was abrogated with aggressive supportive care, but the patient suffered extensive neurologic sequelae as a result of the event. Serologic testing confirmed the presence of ceftriaxone antibodies.

Topics: Anemia, Hemolytic; Anemia, Sickle Cell; Anti-Bacterial Agents; Antibodies; Brain Ischemia; Ceftriaxone; Child; Female; Hemolysis; Humans

An 18 year female sickler (HbSS) presented with repeated history of epistaxis and bleeding gums. Features consistent with pseudoxanthoma elasticum were observed, such as hyper-extensile redundant skin folds in the neck, axilla, inguinal areas and abdomen. The skin biopsy showed swollen, clumped and fragmented elastic fibres and calcium deposits in the deep and mid reticular dermis, consistent with pseudoxanthoma elasticum. This is a well recognised complication of sickle cell disease which has not been described in Kenya.

Topics: Acetaminophen; Adolescent; Analgesics, Non-Narcotic; Anemia, Sickle Cell; Anti-Bacterial Agents; Ceftriaxone; Epistaxis; Female; Folic Acid; Humans; Pseudoxanthoma Elasticum; Vitamin B Complex

Ceftriaxone can be associated with catastrophic immune hemolysis in pediatric patients, particularly those with underlying diseases such as sickle cell disease and human immunodeficiency virus infection. We designed a study to screen for ceftriaxone-induced RBC antibodies in these 2 pediatric populations. The prevalence of anticeftriaxone antibody was 12.5% (8 of 64). Two of these 8 patients with the antibody experienced hemolysis; 1 case was fatal.

Topics: Adult; Anemia, Sickle Cell; Autoantibodies; Ceftriaxone; Erythrocytes; Hemolysis; HIV Infections; Humans; Infant; Infant, Newborn

Human cases due to Salmonella enterica subsp. arizonae are especially rare, but it may affect immunocompromised patients and infants. We present a case of endocarditis in a patient with sickle cell disease and a review of earlier cases caused by this rare human pathogen. The patient was successfully treated with ceftriaxone and ciprofloxacin. There are only few cases of salmonella endocarditis reported in the last six decades and it is the first case of Salmonella enterica subsp. arizonae endocarditis in the literature to the best of our knowledge.

Topics: Anemia, Sickle Cell; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Echocardiography; Endocarditis, Bacterial; Female; Humans; Immunocompromised Host; Kidney Function Tests; Middle Aged; Salmonella arizonae

The majority of data evaluating Salmonella infections in sickle cell anemia (SCD) comes from studies performed in children. We report a SCD adult who presented with ceftriaxone-resistant Salmonella bacteremia. After appropriate initial therapy, persistent back pain prompted evaluation by magnetic resonance imaging of the spine, which revealed osteomyelitis and a psoas abscess. The patient responded to percutaneous drainage and antibiotics. This report summarizes some of the findings of large SCD studies evaluating Salmonella bacteremia and osteomyelitis, focusing on adults. Our case exemplifies the need for antibiotic coverage for Salmonella species in adult SCD patients with septicemia. We argue that imaging studies looking for osteomyelitis should be done routinely in SCD patients with Salmonella bacteremia.

Topics: Adult; Anemia, Sickle Cell; Anti-Bacterial Agents; Anti-Infective Agents; Ceftriaxone; Ciprofloxacin; Comorbidity; Humans; Magnetic Resonance Imaging; Male; Osteomyelitis; Psoas Abscess; Salmonella Infections; Salmonella paratyphi C; Sepsis

Hemolysis induced by ceftriaxone is a complication that has been described in sickle cell anemia. Albuterol is known to induce myocardial ischemia. We describe a case of albuterol-induced cardiac dysfunction in a patient with sickle cell anemia who developed severe anemia after administration of ceftriaxone.

Topics: Adrenergic beta-Agonists; Albuterol; Anemia, Hemolytic; Anemia, Sickle Cell; Ceftriaxone; Child; Humans; Male; Myocardial Ischemia

An immune complex mechanism for ceftriaxone sodium- induced severe autoimmune hemolytic anemia has previously been demonstrated using routine blood bank techniques. We describe herein a patient with severe hemolysis that subsided once the drug was discontinued. Serologic techniques demonstrated immune complex-mediated ceftriaxone-dependent red cell antibodies. These findings were further supported by the results of flow cytometry, in which a change in basal red cell autofluorescence was seen in the presence of the antibody and the drug. Our case illustrates the adjunctive value of flow cytometry in the diagnosis of ceftriaxone-dependent red cell antibody.

Topics: Anemia, Hemolytic, Autoimmune; Anemia, Sickle Cell; Antigen-Antibody Complex; Blood Transfusion; Ceftriaxone; Child; Drug Hypersensitivity; Epilepsy, Generalized; Erythrocytes; Flow Cytometry; Fluorescence; Humans; Male; Oxidative Stress; Pneumonia, Bacterial; Respiratory Insufficiency

Sickle-beta(+) (beta(+)) thalassemia is a double heterozygous genetic disorder characterized by both a qualitative and quantitative abnormality. We present a case of an African American male who was first diagnosed with sickle cell disease (SCD) at the age 23 years when he presented with generalized bone pain, fever, and hepatosplenomegaly. Laboratory findings included thrombocytopenia, microcytic anemia, and markedly elevated ferritin. He was subsequently diagnosed with a sickle-beta thalassemia hemoglobinopathy. Findings in the bone marrow aspirate and biopsy were consistent with hemophagocytic lymphohistiocytosis (HLH). HLH resolved with the resolution of sickle cell bone pain crisis without use of immunosuppressive therapy. To the best of our knowledge this is the first documented case of HLH associated with sickle cell bone pain crisis.

Topics: Adult; Anemia, Sickle Cell; Anti-Bacterial Agents; Ceftriaxone; Histiocytosis, Non-Langerhans-Cell; Humans; Immunohistochemistry; Male

We report an unusual child with sickle cell disease, in which osteomyelitis of the sternum and clavicle was diagnosed at the same time. The standard x-ray failed to demonstrate the lesion. Magnetic resonance imaging was very helpful in locating the site and degree of involvement. We recommend the use of magnetic resonance imaging to delineate such findings.

Topics: Anemia, Sickle Cell; Ceftriaxone; Child; Clavicle; Combined Modality Therapy; Drainage; Follow-Up Studies; Humans; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Osteomyelitis; Severity of Illness Index; Sternum; Treatment Outcome

Because hospitalization and intravenous antibiotics for treatment of a potentially fatal bacterial infection in febrile children with sickle cell disease (SCD) are difficult to apply, outpatient treatment has been considered in developed countries for selected patients. Eligibility criteria and procedures may differ in developing countries because of unique economic and social conditions. After clinical evaluation within 36 hr of the onset of a fever exceeding 38.5 degrees C, children with SCD who are being closely followed as a part of a SCD cohort in Cotonou (West Africa), were treated as outpatients. The antibiotic regimen consisted of intramuscular injection of ceftriaxone 50 mg/kg/day for 2 days followed by amoxicillin 25 mg/kg x 3/day x 4 days and oral hyper-hydration. Patients were observed for 6 hr and thereafter discharged with a medical control at day 2, day 8 + day 15. All 60 children included completed their treatment, and none were lost to follow-up. A definite or a presumed bacterial infection was the cause of the febrile episode in 76.7% of cases. An appreciable decrease in fever was observed from day 2 and only 2 patients were hospitalized at day 3, one for abdominal painful crisis and one other for persistent fever without documented infection. No severe bacterial infections, recurrence of febrile episode, nor death were encountered during the follow-up. The cost of this outpatient approach is US $30 per patient as compared to US $140 per patient if the patient had been hospitalized. Outpatient management of febrile episode in children with SCD is feasible and cost-effective in Sub-Saharan African. It requires, however, improved medical education on SCD and immediate medical attention after the onset of fever.

Topics: Abdominal Pain; Administration, Oral; Ambulatory Care; Amoxicillin; Anemia, Sickle Cell; Bacterial Infections; Benin; Ceftriaxone; Child; Child, Preschool; Cohort Studies; Combined Modality Therapy; Developing Countries; Drug Costs; Drug Therapy, Combination; Female; Fever; Fluid Therapy; Follow-Up Studies; Hospitalization; Humans; Infant; Injections, Intramuscular; Malaria, Falciparum; Male; Pilot Projects; Recurrence

We report a case of a cyst of maxillary in a patient suffering from sickle-cell anemia. A review of literature and therapeutic management is exposed.

Topics: Anemia, Sickle Cell; Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Child; Drug Therapy, Combination; Female; Humans; Incisor; Maxillary Diseases; Odontogenic Cysts; Pneumonia, Pneumococcal; Postoperative Complications; Root Canal Therapy; Tooth Fractures; Vancomycin

A 2-year-old boy with sickle cell anemia had a massive, fatal hemolytic reaction after administration of an intravenous dose of ceftriaxone. Laboratory studies demonstrated the presence of an IgM antibody against ceftriaxone, binding to and destroying the patient's erythrocytes by an immune complex mechanism. This rare complication should be considered in the differential diagnosis when hemoglobinuria develops in a child after administration of ceftriaxone or a similar agent.

Topics: Anemia, Hemolytic, Autoimmune; Anemia, Sickle Cell; Ceftriaxone; Child, Preschool; Fatal Outcome; Hemoglobinuria; Hemolysis; Humans; Immunoglobulin M; Male

Topics: Ambulatory Care; Anemia, Sickle Cell; Ceftriaxone; Child; Humans

Topics: Age Factors; Anemia, Sickle Cell; Anti-Bacterial Agents; Bacterial Infections; Body Temperature; Cefaclor; Ceftriaxone; Cefuroxime; Child, Preschool; Cost-Benefit Analysis; Female; Fever; Humans; Infant; Infant, Newborn; Male; Outpatients; Penicillins

A 26-year-old black male with sickle-cell disease developed a Salmonella septic arthritis in one knee and an acute, aseptic arthritis in the other knee. Salmonella is showing increasing resistance to many antibiotics. In this patient, optimal antibiotic treatment of his uncommon infection was delayed by a rare resistance to trimethoprim-sulfamethoxazole. Two pathophysiologic mechanisms could account for his acute, aseptic arthritis: sickle-cell disease with presumed synovial ischemia from sickling and reactive arthritis precipitated by a remote Salmonella infection elsewhere in the body. The authors could find no previous discussion of either of these processes in the orthopedic literature. Acute arthritis in a patient with sickle-cell disease can be a complex diagnostic and therapeutic problem.

Topics: Adult; Anemia, Sickle Cell; Arthritis; Arthritis, Infectious; Ceftriaxone; Humans; Knee Joint; Male; Salmonella enteritidis; Salmonella Infections; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination