What is Ceftriaxone (Rocephin) induced encephalopathy?

From the Guidelines

Ceftriaxone-induced encephalopathy is a rare but serious side effect that requires immediate discontinuation of the antibiotic, and it is crucial to discontinue ceftriaxone at the first signs of encephalopathy to prevent further neurological damage. The provided evidence does not directly discuss ceftriaxone-induced encephalopathy, but based on general medical knowledge, it is known that ceftriaxone can cause neurotoxicity, especially in patients with renal impairment 1. Key points:

• Discontinue ceftriaxone at first signs of encephalopathy
• Consider alternative antibiotics like piperacillin-tazobactam or meropenem
• Monitor renal function, as impaired kidney function increases risk
• Symptoms typically resolve within 2-7 days after stopping ceftriaxone Ceftriaxone can cause neurotoxicity by several mechanisms:

1. It can disrupt the blood-brain barrier
2. It may interfere with GABA neurotransmission
3. In patients with renal impairment, it can accumulate and reach toxic levels in the CNS Prevention involves using the lowest effective dose, especially in elderly patients or those with kidney problems. If encephalopathy occurs, supportive care and close monitoring are essential until symptoms resolve. In most cases, the condition is reversible once the medication is stopped. It is essential to note that the provided evidence focuses on the treatment of community-acquired pneumonia and Lyme disease, but it does not directly address ceftriaxone-induced encephalopathy 1. However, the general principles of antibiotic use and the potential for neurotoxicity are relevant to the discussion of ceftriaxone-induced encephalopathy.

From the FDA Drug Label

In patients undergoing dialysis no additional supplementary dosing is required following the dialysis. In patients with both severe renal and hepatic dysfunction, close clinical monitoring for safety and efficacy is advised. Information for Patients Advise patients that neurological adverse reactions could occur with Ceftriaxone for Injection use Instruct patients or their caregivers to inform their healthcare provider at once of any neurological signs and symptoms, including encephalopathy (disturbance of consciousness including somnolence, lethargy, and confusion), seizures, myoclonus, and nonconvulsive status epilepticus, for immediate treatment, or discontinuation of Ceftriaxone for Injection (see WARNINGS AND PRECAUTIONS) OVERDOSAGE Ceftriaxone overdosage has been reported in patients with severe renal impairment. Reactions have included neurological outcomes, including encephalopathy, seizures, myoclonus, and non-convulsive status epilepticus.

Ceftriaxone-induced encephalopathy is a neurological adverse reaction that can occur with the use of Ceftriaxone for Injection, characterized by:

• Disturbance of consciousness
• Somnolence
• Lethargy
• Confusion It can also be a result of overdosage, particularly in patients with severe renal impairment 2 2.

From the Research

Definition and Overview

• Ceftriaxone-induced encephalopathy is a rare side effect of ceftriaxone treatment, a third-generation cephalosporin antibiotic 3, 4, 5, 6, 7.
• It is characterized by disturbed mental status, including symptoms such as aphasia, loss of contact, chorea-like tongue movements, slurred speech, gait imbalance, nocturnal vomiting, and headache 4, 6.

Risk Factors

• Patients with renal failure or undergoing hemodialysis are at higher risk of developing ceftriaxone-induced encephalopathy 3, 5.
• However, cases have also been reported in patients with normal renal function 4.
• Older adults and those with previous disease of the central nervous system may also be predisposed to this neurotoxicity 7.

Diagnosis and Treatment

• Diagnosis is often based on medical history and suspicion of an adverse drug reaction 3, 4, 5, 6, 7.
• Measuring ceftriaxone levels in the blood and cerebrospinal fluid may be useful for an accurate diagnosis 5.
• Discontinuation of ceftriaxone usually leads to rapid improvement of symptoms 3, 4, 5, 6, 7.
• Electroencephalogram (EEG) may demonstrate triphasic waves suggestive of encephalopathy 3, 6.