Can Ceftriaxone (Rocephin) cause peripheral eosinophilia?

From the Guidelines

Yes, Rocephin (ceftriaxone) can cause peripheral eosinophilia as a side effect. Eosinophilia, defined as an elevated level of eosinophils in the blood (typically >500 cells/μL), occurs in approximately 1-7% of patients receiving ceftriaxone therapy 1. This reaction typically develops within 1-2 weeks of starting the medication and may persist during treatment. The mechanism involves a hypersensitivity reaction where the drug acts as a hapten, binding to proteins and triggering an immune response that leads to eosinophil proliferation and mobilization from bone marrow. Most cases are mild and resolve spontaneously after discontinuation of the medication, though monitoring is recommended. If a patient develops eosinophilia while on Rocephin, clinicians should evaluate for other manifestations of drug hypersensitivity such as rash, fever, or organ involvement. In cases of mild isolated eosinophilia without other symptoms, continuation of therapy may be possible with careful monitoring, but significant eosinophilia (>1500 cells/μL) or accompanying symptoms may warrant discontinuation and consideration of alternative antibiotics.

Key Considerations

• The incidence of eosinophilia in patients receiving ceftriaxone is relatively low, but it is a potential side effect that clinicians should be aware of 1.
• The development of eosinophilia typically occurs within 1-2 weeks of starting ceftriaxone therapy, and it may persist during treatment.
• Clinicians should monitor patients for other manifestations of drug hypersensitivity, such as rash, fever, or organ involvement, and consider alternative antibiotics if significant eosinophilia or accompanying symptoms occur.

Management

• In cases of mild isolated eosinophilia without other symptoms, continuation of ceftriaxone therapy may be possible with careful monitoring.
• Significant eosinophilia (>1500 cells/μL) or accompanying symptoms may warrant discontinuation of ceftriaxone and consideration of alternative antibiotics.
• Clinicians should consider the potential for cross-reactivity between ceftriaxone and other beta-lactam antibiotics, although the evidence suggests that this is relatively low 1.

Alternative Antibiotics

• If ceftriaxone is discontinued due to eosinophilia or other side effects, alternative antibiotics such as amoxicillin/clavulanate, cefpodoxime proxetil, or cefuroxime axetil may be considered 1.
• The choice of alternative antibiotic will depend on the specific clinical scenario and the patient's medical history, including any allergies or previous adverse reactions to antibiotics.

From the Research

Peripheral Eosinophilia and Ceftriaxone (Rocephin)

There is no direct evidence in the provided studies that links Ceftriaxone (Rocephin) to peripheral eosinophilia.

Definition and Classification of Eosinophilia

• Peripheral eosinophilia is defined by a blood eosinophil count > 500 cells/μL 2
• It is classified into mild (500-1500 cells/μl), moderate (1500-5000 cells/μl) and severe for an eosinophil count > 5000 cells /μl 2
• Hypereosinophilia is defined as a blood eosinophil count >1500 cells/μl in at least two consecutive tests made with a minimum of a 4-week interval 2

Causes and Associations of Eosinophilia

• The causes of eosinophilia are various, and can be summarized by the acronym "APLV" which refers to Allergic disorders, Parasitic infections, Leukemia/ Lymphomas (and solid tumors) and Vasculitis-Immunodeficiency diseases 2
• Eosinophilia may be associated with tissue damage and organ involvement, mainly at cardiac, pulmonary and cutaneous level 2, 3
• Drug-induced eosinophilia is a known complication of antimicrobial therapy, and has been associated with certain antibiotics such as vancomycin, penicillin, rifampin, and linezolid 4

Diagnosis and Management of Eosinophilia

• The diagnosis of eosinophilia relies on a combination of morphologic review of the blood and marrow, standard cytogenetics, fluorescent in situ-hybridization, flow immunocytometry, and T-cell clonality assessment 5
• The management of eosinophilia depends on the underlying cause and the presence of organ involvement, and may include watchful waiting, corticosteroids, hydroxyurea, interferon-alpha, and other treatments 5, 2