What to do if a patient exhibits an abnormal gait after a Rocephin (Ceftriaxone) injection?

Immediate Assessment and Management of Abnormal Gait After Rocephin (Ceftriaxone) Injection

Stop immediately and evaluate for sciatic nerve injury if the injection was intramuscular, as this represents the most likely cause of gait abnormality following Rocephin administration and requires urgent neurological assessment.

Initial Clinical Evaluation

Determine Injection Site and Route

• Identify whether the injection was intramuscular (IM) or intravenous (IV), as IM injections carry risk of nerve injury if improperly placed 1
• Assess the exact anatomical location where the injection was administered—improper IM technique can cause sciatic nerve damage leading to foot drop and abnormal gait 2
• Document the time interval between injection and onset of gait abnormality to distinguish acute nerve injury from other complications 3

Perform Focused Neurological Examination

• Evaluate for lower limb motor weakness or sensory disturbance, which are warning signs requiring urgent medical attention after any injection procedure 2
• Test for foot drop or inability to dorsiflex the foot, which indicates sciatic nerve involvement 2
• Assess for perineal sensory disturbance, urinary retention, or fecal incontinence, as these suggest cauda equina syndrome requiring emergency intervention 2
• Perform the clasping test: lift the patient and observe if they retract limbs toward the abdomen rather than spreading them, indicating paresis 2
• Conduct the grip test: have the patient grip a surface while you gently pull them back by supporting their trunk—inability to maintain grip suggests neurological compromise 2

Differential Diagnosis and Specific Complications

Nerve Injury from Injection (Most Likely)

• Sciatic nerve injury from IM injection is the primary concern when gait abnormality develops immediately after Rocephin administration, particularly if injected into the gluteal region 2
• Symptoms include foot drop, inability to walk normally, and sensory changes in the distribution of the affected nerve 2
• This represents a medical emergency requiring immediate cessation of further injections and neurological consultation 2

Neurological Adverse Reactions (Less Common but Serious)

• Serious neurological adverse reactions have been reported with ceftriaxone, including encephalopathy (somnolence, lethargy, confusion), seizures, myoclonus, and non-convulsive status epilepticus 1
• These reactions are reversible and resolve after discontinuation of ceftriaxone 1
• Evaluate for altered mental status, confusion, or seizure activity in addition to gait abnormality 1

Subcutaneous Extravasation (If IV Attempted)

• Accidental subcutaneous administration can cause local tissue injury and pain affecting mobility 3
• Look for swelling, erythema, or tenderness at the injection site 3

Immediate Management Algorithm

Step 1: Discontinue Ceftriaxone

• Stop all further doses of Rocephin immediately if neurological adverse reactions are suspected 1
• Do not administer additional injections until the cause is identified 1

Step 2: Provide Supportive Care

• Place the patient in a recumbent position if they are unstable or at risk of falling 2
• Monitor vital signs including heart rate, blood pressure, pulse oximetry, and temperature 2
• Assess for signs of anaphylaxis (hypotension, respiratory distress, urticaria) which can occur with ceftriaxone, though gait abnormality alone is not typical of anaphylaxis 2, 1

Step 3: Obtain Emergency Consultation

• Arrange immediate neurological consultation if motor weakness, sensory deficits, or foot drop are present 2
• Consider emergency imaging (MRI of spine) if cauda equina syndrome is suspected based on urinary retention, fecal incontinence, or saddle anesthesia 2
• Document the incident thoroughly including injection technique, site, volume, and timeline of symptom onset 1

Step 4: Institute Appropriate Supportive Measures

• If neurological adverse reactions are confirmed, discontinue ceftriaxone and provide supportive care until symptoms resolve 1
• Adjust dosing in patients with severe renal impairment if continuation of ceftriaxone is necessary, as inappropriate dosing increases risk of neurological complications 1
• Advise the patient to seek urgent medical attention for new-onset severe back or leg pain, worsening motor weakness, or bladder/bowel dysfunction 2

Critical Pitfalls to Avoid

• Do not dismiss gait abnormality as a minor side effect—it may represent serious nerve injury or neurological complication requiring immediate intervention 1
• Do not continue ceftriaxone without determining the cause of gait abnormality, as neurological adverse reactions are reversible only after discontinuation 1
• Do not delay neurological consultation if objective motor or sensory deficits are present, as early intervention improves outcomes in nerve injury 2
• Ensure proper IM injection technique for any future administrations: use the ventrogluteal site rather than dorsogluteal to avoid sciatic nerve injury 2
• Monitor for delayed complications including postoperative infections if the injection site becomes inflamed, though this is rare with proper technique 4

Patient Education and Follow-Up

• Inform the patient that neurological symptoms from ceftriaxone are reversible and should improve after stopping the medication 1
• Advise against driving until gait normalizes and neurological function is fully restored 2
• Schedule follow-up evaluation within 24-48 hours to assess resolution of symptoms 2
• Document allergy or adverse reaction in the medical record to prevent future administration if ceftriaxone-related neurological toxicity is confirmed 1