ro13-9904 and Embolism

There are a total of 8000 cases of infective endocarditis yearly in the United States. Central nervous system metastatic infections are not uncommon in infective endocarditis. Because ceftriaxone is highly bound to serum proteins, there is concern that the drug is highly bound to serum proteins, there is concern that the drug might not penetrate well in the core of an infected vegetation. To date, there are two published studies on the treatment of nonenterococcal streptococcal endocarditis by ceftriaxone in humans. Ceftriaxone appears to be an attractive alternative antibiotic therapy to conventional regimens in the treatment of streptococcal endocarditis.

Topics: Ambulatory Care; Aneurysm, Infected; Animals; Ceftriaxone; Costs and Cost Analysis; Drug Therapy, Combination; Echocardiography; Embolism; Endocarditis, Bacterial; Heart Failure; Humans; Staphylococcal Infections; Streptococcal Infections

Topics: Ceftriaxone; Clinical Trials as Topic; Cloxacillin; Dextrans; Embolism; Floxacillin; Hip Prosthesis; Humans; Knee Prosthesis; Prospective Studies; Random Allocation; Surgical Wound Infection; Thrombosis

Topics: Aged, 80 and over; Anti-Bacterial Agents; Aortic Valve Stenosis; Ceftriaxone; Computed Tomography Angiography; Embolectomy; Embolism; Endocarditis; Fatal Outcome; Gentamicins; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Postoperative Complications; Streptococcus salivarius; Thrombosis; Transcatheter Aortic Valve Replacement; Ultrasonography, Doppler

In April 2009, the FDA retracted a warning asserting that ceftriaxone and intravenous calcium products should not be coadministered to any patient to prevent precipitation events leading to end-organ damage. Following that announcement, we sought to evaluate if the retraction was justified. A search of the FDA Adverse Event Reporting System was conducted to identify any ceftriaxone-calcium interactions that resulted in serious adverse drug events. Ceftazidime-calcium was used as a comparator agent. One hundred four events with ceftriaxone-calcium and 99 events with ceftazidime-calcium were identified. Adverse drug events were recorded according to the listed description of drug involvement (primary or secondary suspect) and were interpreted as probable, possible, unlikely, or unrelated. For ceftriaxone-calcium-related adverse events, 7.7% and 20.2% of the events were classified as probable and possible for embolism, respectively. Ceftazidime-calcium resulted in fewer probable embolic events (4%) but more possible embolic events (30.3%). Among cases that considered ceftriaxone or ceftazidime and calcium as the primary or secondary drug, one case was classified as a probable embolic event. That patient received ceftriaxone-calcium and died, although an attribution of causality was not possible. Our analysis suggests a lack of support for the occurrence of ceftriaxone-calcium precipitation events in adults. The results of the current analysis reinforce the revised FDA recommendations suggesting that patients >28 days old may receive ceftriaxone and calcium sequentially and provide a transparent and reproducible methodology for such evaluations.

Topics: Adolescent; Adult; Adverse Drug Reaction Reporting Systems; Aged; Aged, 80 and over; Calcium; Ceftriaxone; Chemical Precipitation; Child; Child, Preschool; Drug Interactions; Drug-Related Side Effects and Adverse Reactions; Embolism; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; United States; United States Food and Drug Administration; Young Adult

Patients with endocarditis who present after embolism from a large, mobile vegetation pose a clinical dilemma: should they be managed with early surgery with the aim of preventing further emboli, or should a medical strategy be employed that avoids the morbidity and mortality associated with surgery but which risks further emboli? The management of such a patient is discussed in the context of the published literature regarding embolic risk in endocarditis.

Topics: Adult; Anti-Bacterial Agents; C-Reactive Protein; Ceftriaxone; Echocardiography, Transesophageal; Embolism; Endocarditis, Bacterial; Female; Follow-Up Studies; Humans; Streptococcus agalactiae; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Tricuspid Valve

A 59-year-old female patient with mitral valve prolapse and a previous history of lumbosacral spondyloarthrosis and lumbar disk hernia had an episode of infective endocarditis due to Streptococcus viridans, which evolved with peripheral embolism to the left kidney, spleen, and left iliac artery, and intraventricular cerebral hemorrhage. Her clinical manifestations were low back pain and hematuria, which were initially attributed to an osteoarticular condition. Infective endocarditis is a severe polymorphic disease with multiple clinical manifestations and it should always be included in the differential diagnosis by clinicians.

Topics: Amikacin; Ceftriaxone; Cephalosporins; Embolism; Endocarditis, Bacterial; Female; Hematuria; Humans; Low Back Pain; Middle Aged; Mitral Valve Prolapse; Streptococcus; Vancomycin