November 2021, Volume 71, Issue 11

Student's Corner

A word of caution regarding Ceftriaxone

Naveen Azhar  ( Department of Internal medicine,, Dow University of Health Sciences, Karachi, Pakistan. )
Arooma Shaukat Siddiqui  ( Department of Internal medicine,, Dow University of Health Sciences, Karachi, Pakistan. )
Navaira Shoaib  ( Department of Internal medicine,, Dow University of Health Sciences, Karachi, Pakistan. )

Madam, Ceftriaxone is a well-known antibiotic belonging to the third generation of cephalosporins. This broad-spectrum drug is highly effective against gram negative and gram-positive bacterial infections and is frequently used to treat severe bacterial infections in paediatrics, including disseminated gonococcal infections, sepsis and meningitis. However, concerns have been raised regarding the drug’s safety as it is prone to various side effects like bilirubin encephalopathy, cholestasis, pseudolithiasis and rarely hepatitis and pancreatitis.1

A prospective study in 154 children published in Human and Experimental Toxicology in 2016 further validate this point.2 According to this study, out of 84, 20.9% children treated with ceftriaxone had abnormal biliary sonographic findings and 15.1% had biliary lithiasis whereas cefotaxime was found to be comparatively safer.

Worrying facts related to Ceftriaxone should definitely be taken into consideration as ceftriaxone is a standard treatment for several bacterial infections in children and is being prescribed at a regular basis in many countries. In fact, a clinical study performed in a secondary care hospital of Karachi, Pakistan, declared it the most frequently prescribed antibiotic.3

Physicians should prescribe ceftriaxone with caution. Ceftriaxone should be avoided in neonates especially those with hyperbilirubinaemia. Caution must be advised for the use of intravenous ceftriaxone with intravenous calcium containing solutions as their concomitant use can lead to life threatening adverse reactions.4 Patient should seek medical help if they experience diarrhoea, jaundice, confusion, headache, heart palpitations etc. Similar drugs with a safer adverse effect profile should be considered as a future alternative.


Disclaimer: None.

Conflict of Interest: None.

Funding Sources: None.





1.      Monte S, Prescott W, Johnson K, Kuhman L, Paladino J. Safety of ceftriaxone sodium at extremes of age. Expert Opin. Drug Saf. 2008;7:515-523.

2.      Ustyol L, Bulut M, Agengin K, Bala K, Yavuz A, Bora A et al. Comparative evaluation of ceftriaxone- and cefotaxime-induced biliary pseudolithiasis or nephrolithiasis: A prospective study in 154 children.  Hum Exp Toxicol. 2016;36:547-553.

3.      Ali S, Ahmed S, Lohana H. Trends of Empiric Antibiotic Usage in a Secondary Care Hospital, Karachi, Pakistan. Int. J. Pediatr.2013:2013:1

4.      Bradley J, Wassel R, Lee L, Nambiar S. Intravenous Ceftriaxone and Calcium in the Neonate: Assessing the Risk for Cardiopulmonary Adverse Events. PEDIATRICS. 2009;123:e609-e613.


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