What happens if you take ceftriaxone (a cephalosporin antibiotic) without having a bacterial infection?

Taking Ceftriaxone Without a Bacterial Infection: Risks and Consequences

Taking ceftriaxone without having a bacterial infection is strongly discouraged as it provides no benefit while increasing the risk of developing drug-resistant bacteria and potentially causing harmful side effects.

Primary Risks

Antimicrobial Resistance Development

• The FDA explicitly warns that "prescribing ceftriaxone in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria" 1
• Prolonged use may result in overgrowth of nonsusceptible organisms, requiring careful observation of the patient 1

Superinfection Risk

• Taking ceftriaxone without a bacterial infection can disrupt the normal bacterial flora, potentially leading to superinfections 1
• If superinfection occurs during therapy, appropriate measures must be taken, but this represents an unnecessary risk when no infection is present initially 1

Common Side Effects

Gastrointestinal Effects

• Potential for development of Clostridioides difficile infection 2
• Risk of enterocolitis, which has been reported as a serious side effect 3
• Diarrhea may occur as a common adverse reaction 1

Gallbladder and Urinary Tract Complications

• Ceftriaxone-calcium precipitates can form in the gallbladder, appearing on sonography as echoes that may be misinterpreted as gallstones 1
• Similar precipitates can form in the urinary tract, potentially leading to urolithiasis and post-renal acute renal failure 1
• These conditions are typically reversible upon discontinuation of ceftriaxone 1

Hematological Effects

• Alterations in prothrombin time can occur, especially in patients with impaired vitamin K synthesis or low vitamin K stores 1
• Leukopenia has been reported as a serious side effect 3
• Increased risk of bleeding when used concomitantly with Vitamin K antagonists 1

Hypersensitivity Reactions

• Rash and fever have been reported as potential serious side effects 3
• Cross-reactivity with penicillin allergy occurs in approximately 10% of patients 2

Special Considerations

Renal and Hepatic Function

• While dosage adjustments are not typically necessary for patients with isolated renal or hepatic dysfunction, caution should be exercised in patients with both conditions 1
• Ceftriaxone is not removed by peritoneal or hemodialysis 1

Appropriate Use Guidelines

• Ceftriaxone is indicated for proven bacterial infections or specific prophylactic indications only 1
• The 2021 practice guidance by the American Association for the Study of Liver Diseases emphasizes the importance of antibiotic stewardship—using antibiotics only when necessary and for as short a duration as possible 4

Conclusion

Taking ceftriaxone without a bacterial infection exposes you to all the risks of antibiotic therapy with none of the benefits. The potential consequences include development of antimicrobial resistance, superinfections, and various side effects affecting multiple organ systems. The FDA label explicitly warns against this practice, highlighting the importance of appropriate antibiotic stewardship.