Diarrhoea associated with ceftriaxone and its implications in paediatric patients

We prospectively studied 50 paediatric patients (3 months-12 years) who received 50 mg/kg ceftriaxone, i.v. over 20 min every 12 h for 3-14 days. Diarrhoea, as defined by four bowel movements/day for two consecutive days, occurred in 34% (17) of 50 patients. An additional two patients with diarrhoea were excluded due to the presence of enteroviruses. Diarrhoea occurred after 2-14 (8.7 +/- 3.2) doses and persisted for 2-8 (3.1 +/- 1.7) days. The mean number of bowel movements was 1.2/days before diarrhoea and 5.5/day during the period of diarrhoea (P less than 0.001); the mean number of bowel movements was 1.2/day in 33 patients who did not develop diarrhoea. The average time spent for diaper care was 3.8 min/day/patient before diarrhoea compared with 14.8 min/day/patient during days of diarrhoea (P less than 0.001). Two patients were evaluated for Clostridium difficile and findings were negative. Fifteen of 17 with diarrhoea and eight of 33 without diarrhoea required care for diaper rash. Ceftriaxone therapy was not discontinued in any patient. These data should be considered in patients who receive ceftriaxone therapy.