Ceftriaxone linked to fatal complications in sickle cell patients

Last Updated: 2020-03-12

By Reuters Staff

NEW YORK (Reuters Health) - Immune hemolytic anemia is the most serious adverse drug reaction (ADR) to ceftriaxone in pediatric patients, and it can be deadly in children with sickle cell disease, according to a new systematic review.

"The predisposition of children with sickle cell disease to haemolytic anaemia following ceftriaxone suggests that this antibiotic should be avoided in children with sickle cell disease," Dr. Linan Zeng of Sichuan University in Chengdu, China, and colleagues write in the Archives of Disease in Childhood.

Ceftriaxone is a broad-spectrum cephalosporin often used to treat severe infections in pediatric patients. However, the authors note, the drug has been linked to biliary pseudolithiasis and urolithiasis, and its overall safety has not been studied.

To investigate, the authors looked at 112 studies including 5,717 patients prescribed ceftriaxone, with 1,136 reported ADRs.

Among the 780 ADRs reported in randomized controlled trials and other prospective studies, 37.4% were gastrointestinal, 24.6% were hepatobiliary and 22.3% were administration-site reactions and general ADRs. Three percent of patients had diarrhea, which was the most common ADR.

Six studies that looked for biliary pseudolithiasis found an incidence of 20.7%, while five studies of cholelithiasis showed an incidence of 18.8%.

Eighty-six patients stopped ceftriaxone due to serious ADRs, including 30 with immune hemolytic anemia (34.9%) and 23 with biliary pseudolithiasis (26.7%).

Ten of the patients who developed hemolytic anemia had sickle cell disease, and 11 died.

While the primary studies had limitations including inconsistent terminology and variable timing of examinations, "the fact that prospective studies suggest one in five children will develop biliary pseudolithiasis or cholelithiasis is of concern," the authors write. "A large prospective cohort study with clear diagnostic criteria and blinding of assessors would help establish the clinical significance of lithiasis following ceftriaxone."

SOURCE: https://bit.ly/38Ftk67 Archives of Disease in Childhood, online March 6, 2020.