From the FDA Drug Label
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 Ceftriaxone-induced encephalopathy is a neurological adverse reaction that may occur with the use of ceftriaxone, characterized by:
- Disturbance of consciousness
- Somnolence
- Lethargy
- Confusion Patients experiencing these symptoms should inform their healthcare provider immediately for prompt treatment or discontinuation of ceftriaxone 1
From the Research
Ceftriaxone-induced encephalopathy is a rare but serious side effect that requires immediate discontinuation of the drug and supportive care, as evidenced by a recent case report in 2024 2. If ceftriaxone-induced encephalopathy is suspected:
- Stop ceftriaxone immediately
- Provide supportive care, including hydration and monitoring of vital signs
- Consider alternative antibiotics based on the original indication and susceptibility
- Monitor neurological status closely
- Symptoms typically resolve within 2-7 days after discontinuation Ceftriaxone-induced encephalopathy typically presents with confusion, altered mental status, myoclonus, and seizures, and can occur even in patients with normal renal function, as highlighted in the 2024 case report 2. The mechanism is thought to be related to ceftriaxone's ability to cross the blood-brain barrier and interfere with GABA neurotransmission. Prevention strategies include:
- Using lower doses in patients with renal impairment
- Monitoring for early signs of neurological changes
- Avoiding concurrent use with other neurotoxic medications If encephalopathy occurs, do not rechallenge with ceftriaxone, as supported by a case report in 2022 3. Consider alternative cephalosporins or other antibiotic classes for future treatments, as cross-reactivity is possible but not universal within the cephalosporin class. It is essential to consider the diagnosis of ceftriaxone encephalopathy even in the absence of traditional risk factors, such as renal impairment, as emphasized in the 2024 study 2.