From the Guidelines
Rocephin (ceftriaxone) can potentially lower the seizure threshold, especially in patients with certain risk factors, such as renal impairment or pre-existing seizure disorders, as evidenced by studies on beta-lactam antibiotics and their neurotoxic effects 1. The mechanism by which ceftriaxone and other beta-lactam antibiotics may cause neurotoxicity, including lowering the seizure threshold, involves the inhibition of GABA-A receptors in the brain, leading to neuronal hyperexcitability 1. Key risk factors for neurotoxicity and potentially lowered seizure threshold include:
- High doses of the antibiotic
- Renal impairment, which can lead to accumulation of the drug
- Pre-existing seizure disorders
- Advanced age
- Central nervous system disorders
- Rapid administration of the antibiotic
- Combination with other medications known to lower the seizure threshold It is crucial to monitor patients on ceftriaxone, especially those with risk factors, for signs of neurotoxicity, such as confusion, hallucinations, myoclonus, or seizures, and to consider alternative antibiotics or closer monitoring when appropriate 1. The most recent and highest quality study suggests that exceeding plasma free concentrations of beta-lactam antibiotics above eight times the MIC can be dangerous and may lead to neurotoxicity, including seizures 1. Therefore, it is essential to use ceftriaxone judiciously, considering the potential risks and benefits, and to be aware of the signs of neurotoxicity to ensure the best possible outcome for patients 1.
From the Research
Seizure Threshold and Rocephin (Ceftriaxone)
- The relationship between Rocephin (ceftriaxone) and seizure threshold is not directly addressed in most of the provided studies 2, 3, 4, 5.
- However, one study suggests that cephalosporins, including ceftriaxone, may lower the seizure threshold by decreasing inhibitory transmission in the brain 6.
- This study notes that predisposing factors, such as damage to the blood-brain barrier, high doses of antibiotics, or renal failure, can increase the risk of epileptic seizures during antibiotic therapy, including with cephalosporins like ceftriaxone 6.
- It is recommended that in patients with a risk of epileptic seizures or diagnosed epilepsy, an antibiotic with a low proconvulsive potential should be selected, and the dose should be adequately adjusted, especially in individuals with renal failure 6.
Clinical Use and Safety of Ceftriaxone
- Ceftriaxone is generally recognized as safe and effective for the treatment of serious infections, including septicemia, in both adults and children 2, 3, 4, 5.
- The long serum half-life of ceftriaxone allows for once-daily or less frequent administration, which can result in substantial cost savings and increased patient compliance 2, 3, 4.
- Clinical studies have demonstrated the efficacy and safety of ceftriaxone in treating various infections, including bacterial meningitis, respiratory tract infections, urinary tract infections, and gonorrhea 2, 3, 4, 5.