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Safety of ceftriaxone sodium at extremes of age

Scott V Monte1, William Allan Prescott, Kristin K Johnson

  • 1Diabetes and Cardiovascular Research, CPL Associates, LLC, 3980 Sheridan Drive, Amherst, NY 14226, USA. smonte@cplassociates.com

Expert Opinion on Drug Safety
|September 2, 2008
PubMed

Insights

Ceftriaxone use in neonates and the elderly requires caution due to precipitation risks. Avoid ceftriaxone in neonates, especially with calcium or hyperbilirubinemia, and consider restrictions in the elderly when using intravenous calcium.

Area of Science:

  • Pharmacology
  • Neonatal Medicine
  • Geriatric Medicine

Background:

  • Reports of neonatal and infant deaths linked to ceftriaxone-calcium precipitation in vital organs.
  • US FDA recommendation (June 2007) against simultaneous administration of ceftriaxone and calcium-containing solutions.
  • Potential for precipitation in lungs and kidneys necessitates careful consideration of drug interactions.

Purpose of the Study:

  • To comprehensively review existing literature on ceftriaxone safety.
  • Focus on safety in two vulnerable populations: neonates (≤28 days) and geriatric patients (≥65 years).

Main Methods:

  • Conducted a multi-database literature search.
  • Included original research, review articles, and case reports.
  • Focused on studies addressing ceftriaxone safety in neonatal and geriatric cohorts.

Main Results:

  • Ceftriaxone precipitation is a significant risk, particularly in neonates.
  • Concomitant administration with intravenous calcium solutions increases risk.
  • Hyperbilirubinemia in neonates is an additional risk factor.

Conclusions:

  • Ceftriaxone should be avoided or minimized in neonates, especially those receiving intravenous calcium or with hyperbilirubinemia.
  • Potential restrictions on ceftriaxone use in geriatric patients receiving intravenous calcium are suggested.
  • Careful risk-benefit assessment is crucial when prescribing ceftriaxone to these populations.
Abstract

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