Scientific Poster Session IV - Case Reports

Abstract

Ceftriaxone is a commonly used third-generation cephalosporin antibiotic that is well-tolerated and can be administered as an intravenous (IV) push. Anaphylaxis to ceftriaxone is rare, and there have been limited post-marketing reports of dermatologic reactions that range in severity. Ceftriaxone-induced cardiac arrest is rare, and there have been six case reports world-wide of ceftriaxone-induced cardiac arrest, two of which were fatal. Proposed explanations of ceftriaxone-induced cardiac arrest include Kounis Syndrome and the combination of proton pump inhibitors (PPI) with ceftriaxone.

Case:

We report three ceftriaxone-induced cardiac arrests occurring over five months in a community hospital system. Patients included are a 46-year-old female, a 53-year-old male, and a 65-year-old male. No patients had an allergy to ceftriaxone and all patients had documentation of previously tolerating ceftriaxone. Each patient received one gram of ceftriaxone via IV push for different indications, including urinary tract infection, community acquired pneumonia, and spontaneous bacterial peritonitis. One patient had a PPI as a home medication while another patient was started on a PPI while inpatient. All three patients scored a three on the Naranjo Adverse Drug Reaction Probability Scale, indicating that the reaction was possibly caused by ceftriaxone. Ultimately, two of these patients expired.

Discussion:

When comparing the cases presented in this report, there were no obvious alternative causes for cardiac arrest. Our hospital system had previously switched from administering certain antibiotics doses as IV piggyback to IV push due to fluid shortages; however, after considering the outcomes of these three patients, we reverted to administering ceftriaxone via IV piggyback.

Conclusion:

Ceftriaxone-induced cardiac arrest is not well defined in literature, but the three cases presented in this report may indicate that when ceftriaxone is administered as an IV push or concomitantly with a PPI, it could be associated with cardiac arrest.

Presenting Author

Authors