ro13-9904 and Drug-Hypersensitivity

Although hemodialysis-hypersensitivity reactions have various causes, only a few cases of hypersensitivity to acetate dialysate accompanied by fever have been reported. We present the case of a 69-year-old hemodialysis patient who was admitted due to fever after dialysis. He had undergone online hemodiafiltration using acetate-free citrate-containing dialysate. After admission, we switched to acetate-containing bicarbonate dialysate. He was diagnosed with pneumonia and treated with ceftriaxone. However, fever that occurred post dialysis persisted, displaying a gradual elevation in CRP level and eosinophils (up to 9.7 mg/dL and 3774 cells/μL, respectively). After a series of negative workups for infection and dialysis membrane allergy, we suspected that acetate-containing bicarbonate dialysate to be the cause of the allergic reaction and switched to acetate-free bicarbonate dialysate. Consequently, eosinophil count decreased and the fever abated. The drug-induced lymphocyte stimulation test finding (for acetate dialysate) was positive, and he was diagnosed with acetate dialysate-induced hypersensitivity reactions. The condition was not detected earlier due to the complications associated with pneumonia.

Topics: Acetates; Aged; Anti-Bacterial Agents; Bicarbonates; C-Reactive Protein; Ceftriaxone; Dialysis Solutions; Drug Hypersensitivity; Eosinophils; Fever; Hemodiafiltration; Humans; Male; Pneumonia; Renal Dialysis

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.

Topics: Adult; Adverse Drug Reaction Reporting Systems; Anti-Bacterial Agents; Ceftriaxone; China; Databases, Factual; Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Incidence; Infusions, Intravenous; Injections, Intradermal; Male; Skin Tests

Syphilis has challenged scientists and clinicians since its first appearance in the late 1400s and debate continues to surround the best practice in management. Difficulties in defining the goals of successful treatment have contributed to problems in determining recommendations for the ideal management. Treatment regimens currently in use were developed before randomised controlled trials became standard. This, combined with national differences in disease definition, staging and varying interpretations of the studies, as well as the emergence of complicating comorbid conditions, such as HIV, has resulted in a lack of consensus for treatment. This paper will discuss the history and current treatment of syphilis focusing on dilemmas faced by clinicians today, including the emergence of a resistant strain. Despite the difference between current national guidelines, penicillin G largely remains the treatment of choice. Close follow up, monitoring and ensuring adequate compliance remain the most important aspects in the treatment of syphilis.

Topics: Anti-Bacterial Agents; Ceftriaxone; Doxycycline; Drug Hypersensitivity; Female; HIV Infections; Humans; Infant, Newborn; Patient Compliance; Penicillin G; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications, Infectious; Randomized Controlled Trials as Topic; Syphilis

Topics: Aged; Ceftriaxone; Cephalosporins; Drug Hypersensitivity; Humans; Hypersensitivity, Immediate; Male; Radioallergosorbent Test; Single-Blind Method; Skin Tests

Topics: Aged; Ceftriaxone; Cephalosporins; Drug Hypersensitivity; Humans; Hypersensitivity, Immediate; Male; Single-Blind Method; Skin Tests

Topics: Amoxicillin; Capsules; Ceftriaxone; Drug Compounding; Drug Hypersensitivity; Humans; Hypersensitivity; Patch Tests

We present the case of a patient who was unable to tolerate rapid drug desensitization protocol to receive a continuous penicillin (PCN) G infusion for the treatment of neurosyphilis. A 38-year-old male with past medical history for human immunodeficiency virus, migraines, PCN allergy, doxycycline allergy, shellfish allergy, and untreated latent syphilis presented to the emergency room for a posterior migraine with associated nausea, vomiting, photophobia, right-sided paresthesias, and "shaky" vision. He was diagnosed with neurosyphilis and underwent rapid drug desensitization with the goal to receive a continuous infusion of PCN G. The patient's hospital course was complicated by intermittent drug reactions consisting of tachycardia, rash, and dyspnea, followed by periods of being able to tolerate the infusion. After being able to tolerate the recommended dose of PCN infusion, the patient was discharged home to complete the course. However, he returned almost immediately after a recurrence of symptoms at home requiring the use of intramuscular epinephrine. Ultimately, the patient was transitioned to ceftriaxone and completed the infusion course as an inpatient because of continued intermittent recurrence of drug reaction symptoms.

Topics: Adult; Ceftriaxone; Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Humans; Hypersensitivity; Male; Neurosyphilis; Penicillins

Betalactam antibiotics are the most frequent cause of hypersensitivity reactions. Rapid drug desensitization (RDD) is a technique that induces temporary tolerance to a drug allowing a patient to receive the optimal agent. The increased use of RDD and the lack of standardization among available protocols in terms of formulation, starting dose, number of steps and dosing frequency make it essential to determine the safety and appropriate management of these protocols, especially regarding reconstitution, diluents, stability and drug administration in order to guarantee reproducibility. We reviewed betalactam desensitization protocols in a tertiary hospital, in accordance with currently published practices and evaluated its use on patients over a period of three years.. (a) We performed a literature search in PubMed, MEDLINE and Google Scholar databases for case reports and/or systematic reviews describing desensitization protocols for betalactam antibiotics. Pharmacokinetic parameters and physicochemical stability were checked for each antibiotic. (b) We retrospectively reviewed inpatients undergoing our antibiotic desensitization protocols from February 2018 to January 2021. Data and outcomes of desensitization procedures were analysed.. We developed nine RDD protocols: meropenem, ceftriaxone, ceftazidime, ampicillin, ceftolozane/tazobactam, cloxacillin, piperacillin/tazobactam, amoxicillin/clavulanate and penicillin G sodium. Five antibiotics have RDD protocols for two different doses, adjusted to patients with impaired renal function. Detailed data (diluent, total dose, volume, concentrations, duration and stability) of the protocol of each antibiotic used are provided. 28 desensitizations were performed in 17 patients, three of them with confirmed allergies by skin test. 26 out of 28 (92.9%) of them were successfully completed, including those three with positive skin results. The pathogens most frequently involved were E. faecalis and P. aeruginosa; both frequently associated with bacterial resistance. Meropenem, ceftriaxone and ceftazidime were the antibiotics most desensitized. 25 out of 26 (96.1%) procedures were successful in resolving the infection.. Detailed information about compounding, dilution and stability is crucial to ensure safe and successful desensitization processes, as well as good coordination between the Allergy and Pharmacy departments. The increase in bacterial resistance to many of the commercially available antibiotics limits the therapeutic options for treating multidrug-resistant infections; in those situations, antibiotic desensitization may be a key therapeutic option. Although there is a broad consensus in limiting the use of RDD to patients with confirmed allergy, in usual clinical practice its application in those strongly suspected of having type I hypersensitivity is still observed. Our betalactam desensitization protocols have shown themselves to be safe and effective, as evidenced by data from the 17 patients on whom they have been tested.

Topics: Anti-Bacterial Agents; Ceftazidime; Ceftriaxone; Drug Hypersensitivity; Humans; Meropenem; Reproducibility of Results; Retrospective Studies; Review Literature as Topic; Tazobactam

New antigens deriving from -lloyl and -llanyl, major and minor determinants, respectively, were produced for β-lactam antibiotics cefuroxime, cefotaxime, ceftriaxone, meropenem and aztreonam. Twenty β-lactam antigens were produced using human serum albumin and histone H1 as carrier proteins. Antigens were tested by multiplex in vitro immunoassays and evaluated based on the detection of specific IgG and IgE in the serum samples. Both major and minor determinants were appropriate antigens for detecting specific anti-β-lactam IgG in immunised rabbit sera. In a cohort of 37 allergic patients, we observed that only the minor determinants (-llanyl antigens) were suitable for determining specific anti-β-lactam IgE antibodies with high sensitivity (< 0.01 IU/mL; 24 ng/L) and specificity (100%). These findings reveal that not only the haptenisation of β-lactam antibiotics renders improved molecular recognition events when the 4-member β-lactam ring remains unmodified, but also may contribute to develop promising minor antigens suitable for detecting specific IgE-mediated allergic reactions. This will facilitate the development of sensitive and selective multiplexed in vitro tests for drug-allergy diagnoses to antibiotics cephalosporin, carbapenem and monobactam.

Topics: Anti-Bacterial Agents; Aztreonam; beta-Lactams; Carbapenems; Cefotaxime; Ceftriaxone; Cefuroxime; Cephalosporins; Cross Reactions; Drug Hypersensitivity; Humans; Immunoglobulin E; Immunoglobulin G; Meropenem; Monobactams; Penicillins; Skin Tests

Acute generalized exanthematous pustulosis (AGEP) is seen uncommonly in children and sometimes shows atypical clinical features in this population. Patch testing can be used effectively in children for the confirmation of the culprit drug in cases of multiple drug use. Here, we report a rare, pediatric case of ceftriaxone-induced AGEP confirmed by patch testing with subsequent recurrence of the skin eruption.

Topics: Acute Generalized Exanthematous Pustulosis; Ceftriaxone; Child, Preschool; Drug Hypersensitivity; Humans; Male; Meningitis, Pneumococcal; Methylprednisolone; Patch Tests; Prognosis; Rare Diseases; Recurrence; Risk Assessment; Treatment Outcome

Topics: Aged; Anaphylaxis; Anti-Bacterial Agents; Ceftriaxone; Drug Hypersensitivity; Fibrin Fibrinogen Degradation Products; Fibrinogen; Humans; Immunoglobulin E; Male; Pulmonary Embolism; Saphenous Vein; Thrombophlebitis; Tomography, X-Ray Computed; Ultrasonography

Topics: Anaphylaxis; Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Clindamycin; Cross Reactions; Dexamethasone; Drug Hypersensitivity; Humans; Hypersensitivity, Immediate; Male; Middle Aged; Skin Tests

One of the most used cephalosporin in clinical practice is ceftriaxone. Anaphylaxis due to the administration of ceftriaxone is considered a rare event. Here, we report a case of fatal anaphylactic shock after the administration of ceftriaxone in a child who had tolerated the drug in past exposures. The allergic pathogenesis is sustained by the clinical data (short time between the inoculation of the drug and the onset of the symptoms; past exposure to the same molecule and probable sensitization) and the postmortem examination findings (polivisceral congestion and intense eosinophilia found in the histological examination).

Topics: Anaphylaxis; Anti-Bacterial Agents; Autopsy; Ceftriaxone; Child, Preschool; Drug Hypersensitivity; Fatal Outcome; Humans; Male; Retrospective Studies

Two patients from Eritrea, recently arrived in the Netherlands, presented with fever and were investigated for malaria. Bloodfilms showed spirochetes but no blood parasites. Louse-borne relapsing fever caused by Borrelia recurrentis was diagnosed. Treatment was complicated by severe Jarisch-Herxheimer reactions in both patients. Physicians should be aware of the possibility of B. recurrentis infection in migrant populations who travel under crowded conditions, especially after passing through endemic areas such as Ethiopia and neighbouring countries.

Topics: Animals; Anti-Bacterial Agents; Borrelia; Ceftriaxone; DNA, Bacterial; Doxycycline; Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Eritrea; Female; Humans; Lice Infestations; Male; Netherlands; Pediculus; Real-Time Polymerase Chain Reaction; Relapsing Fever; RNA, Ribosomal, 16S; Travel; Treatment Outcome; Young Adult

Recent studies have demonstrated a low cross-reactivity between β-lactam antibiotics and carbapenems in IgE-mediated reactions. There are no studies on cross-reactivity of meropenem in patients with non-immediate hypersensitivity to cephalosporins. We describe a case of a 13-year-old male, admitted in Neurosurgery with a severe extradural empyema complicating frontal sinusitis, submitted to an emergent bifrontal craniotomy. A generalized maculopapular exanthema, fever and malaise, appeared by the 7th day of meningeal doses of ceftriaxone, clindamycin and vancomycin. Those were replaced by meropenem, with posterior worsening of the reaction and mucosal involvement. A new scheme with amikacin, metronidazole and linezolid was done with improvement. Skin prick, intradermal and patch tests to penicillins, ceftriaxone and meropenem were negative. Lymphocyte transformation test was positive to ceftriaxone and negative to meropenem.Non-immediate T cell mechanism seems to be involved. Diagnosis work-up couldn't exclude cross-reactivity between ceftriaxone and meropenem.

Topics: Adolescent; Anti-Bacterial Agents; Antibody Specificity; Ceftriaxone; Cross Reactions; Drug Hypersensitivity; Drug Substitution; Humans; Hypersensitivity, Delayed; Immunoglobulin E; Intradermal Tests; Lymphocyte Activation; Male; Meropenem; Predictive Value of Tests; Risk Factors; Thienamycins

Hoigne's syndrome is characterized by the development of acute clinical manifestations which are mainly psycho-sensorial. Classically, these features immediately follow the injection of procaine penicillin G.. We report a 59-year-old man who presented with psycho-organic manifestations that occurred just after the intravenous injection of ceftriaxone; to our knowledge, this is the first case of Hoigne's syndrome reported after an injection of this antibiotic.. The pathophysiologic basis of this syndrome is still unknown. It is important to keep in mind its clinical characteristics, which may mimic immuno-allergic symptoms. It should be differentiated from anaphylactic manifestations because Hoigne's syndrome allows the continuation of the treatment.

Topics: Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Drug Hypersensitivity; Humans; Injections, Intravenous; Male; Middle Aged; Syndrome

A 24-year-old male patient presented with acute coronary syndrome with ST elevation following an allergic reaction to ceftriaxone. A coronary angiogram revealed ectasia and slow coronary flow in the right coronary artery, whereas the left coronary system was found to be normal. The patient was transferred to the coronary intensive care unit and given steroids, antihistamines, acetylsalicylic acid, clopidogrel, low–molecular weight heparin, and diltiazem. In this case study, we presented acute coronary events following an allergic reaction to ceftriaxone.

Topics: Acute Coronary Syndrome; Anti-Bacterial Agents; Ceftriaxone; Coronary Vessels; Dilatation, Pathologic; Drug Hypersensitivity; Electrocardiography; Humans; Male; Myocardial Infarction; Young Adult

Ceftriaxone, a third-generation cephalosporin antibiotic, is used for a vast variety of infectious diseases. Different types of adverse reactions are reported to be induced by ceftriaxone; however, there is limited published information on spontaneous adverse reactions collected by a national pharmacovigilance centre. This study was conducted to evaluate ceftriaxone-induced adverse drug events, registered in the Iranian pharmacovigilance database during a 10-year period, and to identify preventive measures for reducing ceftriaxone-induced adverse events.. All adverse events registered in the Iranian pharmacovigilance database from 1998 through 2009 were screened for ceftriaxone-related adverse events. The extracted data were categorized based on patients' demographics and previous history of allergic reactions to antibiotics. Assessment of system-organ classes, seriousness and causality of reactions was performed according to World Health Organization scale. The preventability was analysed based on Schumock questionnaire.. Ceftriaxone was responsible for the highest number of deaths in our database (49 cases). Of 20,877 reports, 1205 (5·8%) were related to ceftriaxone; 357 reports (30%) are categorized as serious including cardiac arrest, anaphylactic and anaphylactoid reactions. The high number of serious cases makes it necessary to develop preventive measures for reducing those adverse events. Unlabelled use of the drug (2·9%) is identified as one of the risk factors for adverse events. Evaluation of the 1030 intravenous injections of the drug shows that rapid intravenous injection of ceftriaxone is another risk factor. One hundred and sixteen patients (9·6%) had a previous history of allergic reaction to ceftriaxone, penicillin or both. We recommend an alternative antibiotic, if possible, in the case of a positive history of allergic reaction to cephalosporins, penicillins and/or other beta-lactam antibiotics.. Severe and life-threatening adverse reactions induced by ceftriaxone are of great concern. Rapid intravenous injection, unlabelled use and previous patient history of allergic reactions to cephalosporins or penicillins are risk factors that should be guarded against.

Topics: Adolescent; Adult; Adverse Drug Reaction Reporting Systems; Aged; Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Cross Reactions; Databases, Factual; Drug Hypersensitivity; Female; Humans; Infant; Injections, Intravenous; Iran; Male; Middle Aged; Off-Label Use; Risk Factors; Young Adult

Topics: Aged; Asthma; Ceftriaxone; Cephalosporins; Drug Hypersensitivity; Female; Humans; Takotsubo Cardiomyopathy

Kounis syndrome has been known as allergenic angina and/or allergenic myocardial infarction following an allergic reaction. Probable allergic insults usually include drugs, latex, and food. Although ceftriaxone administration has been associated with various allergic reactions such as urticaria, angioedema, erythema, rash and anaphylactic shock, as far as we know, there is no published report that has shown an association between ceftriaxone use and Kounis syndrome. Here, we describe the first report of allergic vasospasm, culminating in acute inferior myocardial infarction, probably as the result of an acute allergenic reaction, after ceftriaxone use.

Topics: Adult; Angina Pectoris; Anti-Bacterial Agents; Ceftriaxone; Coronary Angiography; Coronary Vasospasm; Drug Hypersensitivity; Electrocardiography; Humans; Male; Myocardial Infarction; Nitroglycerin; Syndrome; Vasodilator Agents

The association of an acute coronary syndrome with mast cell activation secondary to allergen exposure is known as the Kounis syndrome. We present two cases of the Kounis syndrome: (i) one was misdiagnosed as acute ST elevation myocardial infarction and treated with thrombolytics; (ii) the second diagnosis was made after a recurrence two months after the first incident.

Topics: Acute Coronary Syndrome; Adult; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ceftriaxone; Coronary Angiography; Coronary Stenosis; Coronary Vasospasm; Diagnosis, Differential; Drug Hypersensitivity; Female; Humans; Male; Mast Cells; Myocardial Infarction; Recurrence; Syndrome

Drug-related rash with eosinophilia and systemic symptoms (DRESS) syndrome, or drug-induced hypersensitivity syndrome (DIHS), is a life-threatening multiorgan systemic reaction characterized by rash, fever, lymphadenopathy, hepatitis, and leukocytosis with eosinophilia. Aromatic anticonvulsant drugs and allopurinol have been reported to be the most frequent eliciting agents. Our search of the literature revealed only 2 cases induced by piperacillin and 1 case by ceftriaxone.We present 2 cases of DRESS syndrome induced by the beta-lactam drugs ceftriaxone and piperacillin-tazobactam. An allergological workup including skin prick test, intradermal tests, patch tests, and lymphocyte transformation test (LTT) was performed. LTT was shown to be a useful technique in both cases to help to identify the drugs involved.

Topics: Adrenal Cortex Hormones; Adult; Anticonvulsants; beta-Lactams; Ceftriaxone; Cell Proliferation; Cells, Cultured; Colitis, Ulcerative; Drug Hypersensitivity; Eosinophilia; Epilepsy; Exanthema; Female; Histamine Antagonists; Humans; Lymphocyte Activation; Male; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination

Toxic hepatitis or drug-induced liver injury encompasses a spectrum of clinical disease ranging from mild biochemical abnormalities to acute liver failure. The advantages of a long half-life, wide spectrum, high tissue penetration rate, and a good safety profile, make ceftriaxone, a third-generation cephalosporin, a frequent choice in the treatment of childhood infections. Previous studies have reported a few cases of high aspartate aminotransferase and alanine aminotransferase levels, along with three cases of hepatitis caused by ceftriaxone. Here, we report a case of drug-induced toxic hepatitis in a patient who was treated with ceftriaxone for acute tonsillitis.

Topics: Anti-Bacterial Agents; Ceftriaxone; Chemical and Drug Induced Liver Injury; Child; Drug Hypersensitivity; Humans; Liver; Male

Patients with DiHS show an increased risk of sensitization to multiple drugs. We report a case of a young woman who developed cutaneous rash, lymphoadenopathy, malaise and fever after the introduction of phenobarbitale. Because of these symptoms, she was treated with ceftriaxone and she experienced a severe flare-up of the cutaneous and general reaction. Allergological work-up, by cutaneous and lymphocyte transformation test, confirmed a double sensitization to phenobarbital and ceftriaxone. In conclusion, the high risk of DiHS during anticonvulsive therapy should suggest caution in using additional drugs, because of an increased risk of multiple reactions.

Topics: Adult; Cefotaxime; Ceftriaxone; Drug Hypersensitivity; Female; Humans; Lymphocyte Activation; Phenobarbital; Skin Tests

Adverse skin reactions to drugs are frequent, with rates of reaction to many commonly used drugs exceeding 1%. We describe a 29-year-old woman admitted with a history of itching, rash, vesicles on her hands and soles, and edema on her tongue and oropharynx after trimethoprim-sulfamethoxazole, ciprofloxacin, methenamine anhydromethylene citrate, piroxicam, azithromycin, and ceftriaxone intake. Erythema multiforme (EM) was diagnosed by skin biopsy after oral challenge with piroxicam. EM lesions reappeared after oral challenge with levofloxacin. Although EM is quite common with trimethoprim-sulfamethoxazole and there are some reports of EM appearing after intake of ciprofloxacin, it has rarely been attributed to piroxicam and no reports have identified levofloxacin as a cause.

Topics: Adult; Anti-Infective Agents; Anti-Inflammatory Agents, Non-Steroidal; Azithromycin; Ceftriaxone; Ciprofloxacin; Drug Hypersensitivity; Erythema Multiforme; Female; Humans; Levofloxacin; Methenamine; Ofloxacin; Piroxicam; Skin Tests; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We report a case in a 50-year-old male who had been treated with ceftriaxone for 3 weeks to treat meningitis. He was admitted 4 days after cessation of the ceftriaxone treatment with fever, headache, nausea, vomiting, myalgia, arthralgia, pruriginous skin rashes, and with edema on face. Blood tests showed marked eosinophilia and atypic lymphocytosis. He was successfully treated with prednisone p.o. We report this case as we could not recognize a case like this which was induced by ceftriaxone.

Topics: Anti-Bacterial Agents; Ceftriaxone; Drug Eruptions; Drug Hypersensitivity; Eosinophilia; Fever; Humans; Lymphocytosis; Male; Middle Aged; Prednisone

We developed a clinical pathway to optimize the use of antimicrobials by decreasing vancomycin use in preoperative patients with a history of penicillin allergy.. To decrease the use of vancomycin in surgical patients with a self-reported penicillin allergy.. In June 2002, same-day allergy consultation and penicillin skin testing were made available for preoperative patients with self-reported penicillin allergy at the preoperative evaluation (POE) clinic. We reviewed the penicillin allergy skin test results, recommendations, and beta-lactam antibiotic administration outcomes from July 1, 2002, to September 16, 2003.. A total of 1,204 of 11,819 patients were evaluated for beta-lactam allergy at the POE clinic. Of these, 1,120 were approved by the institutional review board for inclusion in the study and 9 were excluded from the study. Of the remaining 1,111 patients, 1,030 (93%) underwent skin testing for penicillin allergy. Forty-three (4%) had a positive skin test result to penicillin. A total of 947 (85%) of the 1,111 patients with a history of beta-lactam allergy were advised to use a beta-lactam antibiotic, and 164 (15%) were advised to avoid beta-lactams. A total of 955 patients (86%) actually received preoperative antibiotics. Of these 955 patients, 716 (75%) received cefazolin, and only 149 (16%) received vancomycin compared with 30% historical controls (P < .01). Among the patients with a negative penicillin skin test result who received a cephalosporin, 5 (0.7%) of 675 experienced an adverse drug reaction to a cephalosporin.. Establishment of a clinical pathway in a preoperative clinic that includes allergy consultation and penicillin skin testing reduced vancomycin use to only 16% in surgical patients with a history of beta-lactam allergy.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; beta-Lactams; Cefazolin; Ceftriaxone; Cephalosporins; Ciprofloxacin; Clindamycin; Critical Pathways; Drug Hypersensitivity; Female; Humans; Male; Middle Aged; Penicillins; Preoperative Care; Skin Tests; Treatment Outcome; Vancomycin

Radiocontrast media (RCM) is used commonly in clinical practice, and can be associated with significant adverse effects. We report a patient who experienced severe anaphylaxis after being given multiple drugs. Challenge testing established allergy to both RCM and ceftriaxone. Premedication did not prevent recurrence of anaphylaxis on repeat challenge with RCM. The haemodynamic and serum tryptase consequences of the challenges are discussed, and a summary of RCM allergy is provided.

Topics: Anaphylaxis; Anti-Bacterial Agents; Ceftriaxone; Contrast Media; Drug Hypersensitivity; Humans; Male; Middle Aged; Premedication; Treatment Failure

A 48-year-old woman with a questionable history of an unspecified ceftriaxone allergy was treated with cefazolin for surgical antibiotic prophylaxis. After she tolerated cefazolin therapy for 4 days, the medical staff concluded that her allergy history was inaccurate, and she was treated with intravenous ceftriaxone for suspected nosocomial pneumonia. Approximately 10 minutes after the start of the infusion, the patient experienced anaphylaxis. Initial symptoms of oral angioedema and laryngopharyngeal constriction progressed to dyspnea, tachypnea, hypotension, and tachycardia, all of which quickly resolved after immediate treatment with hydrocortisone, diphenhydramine, and epinephrine. Skin testing with cefazolin, cefepime, and ceftriaxone revealed that the likely allergic determinant mediating the patient's hypersensitivity reaction was the unique ceftriaxone R2 side chain and not the beta-lactam ring, which initially was suspected by the physician. Immunoglobulin E-mediated hypersensitivity reactions to cephalosporins may occur due to antibody complexes with the beta-lactam ring or various cephalosporin side chains. Misconceptions regarding the nature of cephalosporin allergies complicate antibiotic selection for patients with questionable allergy histories and may lead to inappropriate drug reexposure and anaphylaxis. Detailed understanding of the antigenic determinants that mediate hypersensitivity reactions is essential for clinicians to avoid type 1 reactions in patients with a suspected allergy to cephalosporins.

Topics: Anaphylaxis; Cefazolin; Ceftriaxone; Cephalosporins; Drug Hypersensitivity; Female; Humans; Middle Aged; Skin Tests; Structure-Activity Relationship

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

Topics: Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Cephalexin; Child, Preschool; Cross Reactions; Drug Hypersensitivity; Female; Humans; Penicillins

Topics: Agglutination Tests; Anemia, Hemolytic; Anti-Bacterial Agents; Cefotetan; Ceftriaxone; Diagnosis, Differential; Drug Hypersensitivity; Humans

Topics: Adult; Anaphylaxis; Anti-Bacterial Agents; Ceftriaxone; Cross Reactions; Dermatitis, Occupational; Diagnosis, Differential; Drug Hypersensitivity; Facial Dermatoses; Humans; Hypersensitivity, Delayed; Hypersensitivity, Immediate; Intradermal Tests; Male

Life-threatening anaphylaxis developed in a 5-y-old boy with septic shock within minutes of receiving his first intravenous injection of ceftriaxone. Hypersensivity could not be demonstrated by skin testing and ceftriaxone-specific IgE. However, an in vivo, controlled, intravenous challenge was clearly positive.. Clinicians should be aware of the possibility of anaphylaxis occurring with the first dose of ceftriaxone, especially since such a reaction could go unnoticed in patients with life-threatening infections and unstable vital signs.

Topics: Anaphylaxis; Ceftriaxone; Child, Preschool; Drug Hypersensitivity; Follow-Up Studies; Humans; Injections, Intravenous; Male; Patch Tests; Risk Assessment; Severity of Illness Index; Shock, Septic

In order to investigate the function of T cells in cutaneous adverse drug reactions, skin-derived T cells were analyzed in two patients with a drug-induced exanthem. Skin biopsy specimens were obtained from positive epicutaneous test reactions to amoxicillin and ceftriaxone. Immunohistochemical analysis revealed that the majority of the cell infiltrate in both biopsy specimens was composed of activated T cells, of which some expressed perforin. By limiting dilution 36 amoxicillin-specific and 10 ceftriaxone-specific T cell clones were raised. All of these T cell clones expressed CD4/T cell receptor alphabeta. Cytokine analysis after antigen stimulation of the seven best proliferating T cell clones (four specific for amoxicillin and three for ceftriaxone) revealed that these cells secrete high amounts of interleukin-5 and mostly lower or no amounts of tumor necrosis factor alpha, interleukin-4, and interferon-gamma. A part of these CD4+ T cell clones were cytotoxic, i.e., two selected ceftriaxone-specific T cell clones killed target cells after antigen stimulation. The amoxicillin-specific T cell clones failed to show drug-specific cytotoxicity, but killed target cells in the presence of concanavalin A, indicating a principal ability to be cytolytic. In correlation with the in situ expression of perforin on T cells, the ceftriaxone-specific T cell clones also expressed perforin in vitro. In conclusion, a substantial part of the T cells in drug-induced epicutaneous test reactions are drug specific and are composed of a heterogeneous cell population. Drug-specific T cells producing interleukin-5 may contribute to eosinophilia, whereas cytotoxic CD4+ T cells may account for tissue damage. These data underline the role of T cells in delayed-type cutaneous adverse drug eruptions and drug-induced epicutaneous test reactions.

Topics: Adult; Aged; Aged, 80 and over; Amoxicillin; Ceftriaxone; Cell Separation; Clone Cells; Cytotoxicity, Immunologic; Drug Eruptions; Drug Hypersensitivity; Female; Humans; Interleukin-5; Membrane Glycoproteins; Perforin; Pore Forming Cytotoxic Proteins; Skin Tests; T-Lymphocytes

Topics: Ceftriaxone; Cephalosporins; Cholecystectomy, Laparoscopic; Drug Hypersensitivity; Exanthema; Humans; Hypersensitivity, Delayed; Intradermal Tests; Male; Middle Aged; Patch Tests; Postoperative Complications; Skin Tests

Topics: Adult; Aminoglycosides; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Community-Acquired Infections; Cross Infection; Drug Hypersensitivity; Drug Resistance, Microbial; Drug Resistance, Multiple; Enterococcus; Gram-Negative Bacteria; Humans; Infant, Newborn; Macrolides; Meningitis, Bacterial; Neutropenia; Penicillin Resistance; Penicillins; Pneumonia, Bacterial; Sepsis; Systemic Inflammatory Response Syndrome; Urinary Tract Infections

Topics: Adolescent; Anaphylaxis; Ceftriaxone; Cephalosporins; Drug Hypersensitivity; Humans; Immunoglobulin E; Male; Skin Tests

Topics: Ceftriaxone; Cephalosporins; Drug Hypersensitivity; Humans; Meningitis, Bacterial; Penicillins; Treatment Outcome

The clinical safety of ceftriaxone administered at various doses for time periods ranging from a single injection to up to six weeks was evaluated in 2,640 patients treated in 153 individual studies. The incidence of clinical adverse effects was greatest for gastrointestinal (3.45 percent), hypersensitivity (2.99 percent), and local (1.86 percent) reactions. When the pediatric population was analyzed separately, the incidence of gastrointestinal and hypersensitivity reactions was 5.63 and 3.3 percent, respectively; all other reactions occurred in fewer than 1 percent of patients. The frequency of adverse effects for the once-daily and twice-daily dosing regimens was comparable, except for a statistically significant increase in local reactions when ceftriaxone was administered twice daily. When ceftriaxone was compared directly with other antibiotic regimens, the incidence of clinical adverse effects was similar. Ceftriaxone appears to be safe and well tolerated from a clinical standpoint.

Topics: Adolescent; Adult; Age Factors; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Digestive System; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Hypersensitivity; Female; Humans; Infant; Male; Sex Factors