ro13-9904 and Heart-Arrest

The combination of ceftriaxone and lansoprazole has been shown to prolong the corrected QT interval on electrocardiogram. However, it is unknown whether this translates to clinically important patient outcomes.. To compare lansoprazole with another proton pump inhibitor (PPI) during ceftriaxone treatment in terms of risk for ventricular arrhythmia, cardiac arrest, and in-hospital mortality.. A retrospective cohort study including adult medical inpatients receiving ceftriaxone with lansoprazole or another PPI in 13 hospitals in Ontario, Canada, was conducted from January 1, 2015, to December 31, 2021.. Lansoprazole during ceftriaxone treatment vs other PPIs during ceftriaxone treatment.. The primary outcome was a composite of ventricular arrhythmia or cardiac arrest that occurred after hospital admission. The secondary outcome was all-cause in-hospital mortality. Propensity-score weighting was used to adjust for covariates including hospital site, demographic characteristics, comorbidities, risk factors for ventricular arrhythmia, illness severity, admitting diagnoses, and concomitant medications.. Of the 31 152 patients hospitalized on internal medicine wards who were treated with ceftriaxone while receiving a PPI, 16 135 patients (51.8%) were male, and the mean (SD) age was 71.7 (16.0) years. The study included 3747 patients in the lansoprazole group and 27 405 patients in the other PPI group. Ventricular arrhythmia or cardiac arrest occurred in 126 patients (3.4%) within the lansoprazole group and 319 patients (1.2%) within the other PPI group. In-hospital mortality occurred in 746 patients (19.9%) within the lansoprazole group and 2762 patients (10.1%) in the other PPI group. After weighting using propensity scores, the adjusted risk difference for the lansoprazole group minus other PPI group was 1.7% (95% CI, 1.1%-2.3%) for ventricular arrhythmia or cardiac arrest and 7.4% (95% CI, 6.1%-8.8%) for in-hospital mortality.. The findings of this cohort study suggest that combination therapy with lansoprazole and ceftriaxone should be avoided. More studies are needed to determine whether these findings could be replicated in other populations and settings.

Topics: Adult; Aged; Arrhythmias, Cardiac; Ceftriaxone; Cohort Studies; Female; Heart Arrest; Humans; Inpatients; Lansoprazole; Male; Ontario; Proton Pump Inhibitors; Retrospective Studies

Topics: Adult; Atlanto-Axial Joint; Cardiopulmonary Resuscitation; Ceftriaxone; Heart Arrest; Heroin Dependence; Humans; Hypothermia, Induced; Male; Methicillin-Resistant Staphylococcus aureus; Odontoid Process; Osteomyelitis; Quadriplegia; Substance Abuse, Intravenous; Tomography, X-Ray Computed; Vancomycin

Lyme borreliosis is a multisystem infectious disease with well-known cardiac involvement, including potential carditis as well as conduction abnormalities. We report a case of Lyme disease in a previously healthy 24-year-old male presenting with alternating right- and left-bundle branch block, indicating infra-Hisian atrioventricular (infra-His) block with an accelerated fascicular escape rhythm. Inless than 12 hours, the conduction abnormalities progressed to asystole requiring the urgent placement of a temporary transvenous pacemaker. Subsequently, with appropriate antibiotic treatment, the patient's conduction abnormalities resolved in a week without the need for a permanent pacemaker.

Topics: Anti-Bacterial Agents; Bundle-Branch Block; Cardiac Pacing, Artificial; Ceftriaxone; Electrocardiography; Heart Arrest; Humans; Lyme Disease; Male; Young Adult

The incidence of ceftriaxone-related hypersensitivity skin reactions is between 1% and 3%, whereas anaphylaxis is rare. To the best of our knowledge, the following case is the first report of asystole after the administration of single-dose ceftriaxone. A 55-year-old man was admitted to our emergency department because of high fever, abdominal pain, dysuria, and weakness. To determine the cause of his fever, blood and urine cultures were obtained. Then, an infusion of 1 g ceftriaxone was started slowly. One minute later, cardiac arrest occurred. The rhythm was asystole. Cardiopulmonary resuscitation and tracheal intubation were performed immediately, and the ceftriaxone infusion was discontinued. Within 20 minutes, circulation was restored. The time of onset was suggestive of ceftriaxone-induced anaphylaxis. The patient was discharged in good clinical condition on the 10th day of admission. Emergency physicians should be mindful of the possibility of anaphylaxis and asystole that could occur with the first dose of ceftriaxone and should also make sure to offer receiving detailed informed patient consent, too.

Topics: Anaphylaxis; Anti-Bacterial Agents; Cardiopulmonary Resuscitation; Ceftriaxone; Death, Sudden, Cardiac; Emergency Service, Hospital; Heart Arrest; Humans; Male; Middle Aged

Unsolicited reports regarding potentially serious adverse drug reactions in neonates and young infants were reported to the Food and Drug Administration, leading to changes in the package label for ceftriaxone. This report describes and summarizes the reported cases that led to safety concerns regarding the concurrent administration of intravenous ceftriaxone and calcium in this age group.. Nine reported cases were assessed. The Food and Drug Administration Adverse Event Reporting System database was searched for potential drug interactions in patients who were receiving concomitant ceftriaxone and calcium therapy.. Eight of the reported 9 cases (7 were < or =2 months of age) represented possible or probable adverse drug events. There were 7 deaths. None of the cases were reported from the United States. The dosage of ceftriaxone that was administered to 4 of 6 infants for whom this information was available was between 150 and 200 mg/kg per day. The rate of occurrence of these serious adverse drug reactions cannot be accurately determined from available data.. The concurrent use of intravenous ceftriaxone and calcium-containing solutions in the newborn and young infant may result in a life-threatening adverse drug reaction. Contributing factors for infants in this report may include the use of ceftriaxone at dosages higher than those approved by the Food and Drug Administration, intravenous "push" administration, and administration of the total daily dosage as a single infusion.

Topics: Anti-Bacterial Agents; Calcium Gluconate; Ceftriaxone; Drug Therapy, Combination; Heart Arrest; Humans; Infant; Infant, Newborn; Infusions, Intravenous; Parenteral Nutrition, Total

Myositis is a rare manifestation of Lyme disease of unknown pathogenesis. This study describes the course of disease in eight patients with Lyme disease, aged 37-70 years, all of whom were suffering from histologically proven myositis. The clinical, electrophysiological, and myopathological findings are reported. One patient showed signs and symptoms of myositis of all limbs. In six patients myositis was localized in the vicinity of skin lesions, arthritis or neuropathy caused by Borrelia burgdorferi. In another patient suffering from pronounced muscle weakness of the legs and cardiac arrest, inflammation of the myocardium, the conducting system and skeletal muscles was revealed at autopsy. Muscle biopsy revealed lymphoplasmocellular infiltrates combined with few fibre degenerations in three patients. The lymphoplasmocellular infiltrates were found predominantly in the vicinity of small vessels. Several spirochetes were stained in six of seven muscle biopsy samples by means of the immunogold-silver technique. Culturing of B. Burgdorferi from the muscle biopsy samples was, however, unsuccessful. Antibiotic treatment succeeded in curing the myositis in four of six patients. In one patients signs and symptoms improved. One patient died from cardiac arrest caused by myocarditis and Guillain-Barré syndrome. The outcome is unknown in one patient. Clinical and myopathological findings indicate that Lyme myositis can be caused either by local spreading of B. burgdorferi or an unknown antigen or toxin from adjacent tissues or haematogenously.

Topics: Adult; Aged; Borrelia burgdorferi Group; Cefotaxime; Ceftriaxone; Creatine Kinase; Doxycycline; Drug Therapy, Combination; Female; Heart Arrest; Humans; Immunologic Tests; Isoenzymes; Lyme Disease; Male; Middle Aged; Muscles; Myositis; Penicillin G; Treatment Outcome