Ceftriaxone-Induced Fatal Anaphylaxis Shock at an Emergency Department: A Case Report

Abstract

Anaphylaxis in adults caused by medications such as antibiotics are quite common. To best of our knowledge, the case of anaphylaxis caused by ceftriaxone in our hospital and clinical practice is rare and especially among Saudi patients. A 31-years old Arab female patient was admitted to the emergency (ER) department due to influenza symptoms. Patient was suspected having pneumonia after examination. History indicated that she did not have penicillin allergy in the past, no history of any other concomitant medications, and no other comorbidities. Patient was febrile. At ER department, she was given ceftriaxone 1 g intravenous (IV) and within 15 min the patient started to complain from shortness of breath, bronchospasm and developed irregularity of the vital signs. Patient was suspected experiencing anaphylactic shock. Ceftriaxone was discontinued. Aggressive management started immediately; patient was given oxygen, IM adrenaline, IV hydrocortisone, IV bolus of normal saline, IV ringer lactate, IV pheniramine, and IV ranitidine. Tepid water sponging was provided to control the fever. After resuscitative treatment, patient was stabilized and the vital signs were good. The patient then was moved out to the medical ward. Health care professionals at the Emergency Department should be mindful of the anaphylaxis possibility with patient receiving antibiotics in the cephalosporin group.

Ceftriaxone Induced Cardiopulmonary Arrest: A Fatal Case Report

“…Therefore, in the present case, cardiopulmonary arrest following anaphylaxis to ceftriaxone (Naranjo ADR probability score = 5) [12] was the probable cause of death. Published literature related to ceftriaxoneinduced anaphylaxis [13][14][15][16][17][18][19][20][21][22][23] is shown in Table 1. Moreover, a 10-year review (1998-2008) of reported cases to the Iranian Pharmacovigilance Centre showed that the most frequently reported serious events with ceftriaxone were cardiac arrest and anaphylactic and anaphylactoid reactions [24].…”

Analysis of fatal outcomes associated with ceftriaxone treatment from the Russian database of spontaneous reports

“…Частота реакций гиперчувствительности, вызванных цефтриаксоном, составляет 1-3%, однако частота ана филаксии составляет всего 0,1-0,0001% [7]. При этом случаи АШ при использовании данного АБП, приведшие к летальному исходу, регулярно регистрируются во всем мире [8][9][10], в том числе среди детей [11,12]. В Китае применение цефтриаксона привело к 22 смертям по данным опубликованных с 2002 по 2009 г. клинических случаев [13].…”