Ceftriaxone is NOT Contraindicated in Myasthenia Gravis
Ceftriaxone and other cephalosporins are safe to use in patients with myasthenia gravis, as they are not listed among medications that exacerbate this condition in current clinical guidelines. 1
Evidence Supporting Safety
Beta-lactam antibiotics, including cephalosporins like ceftriaxone, are generally considered safe options for treating infections in myasthenia gravis patients. 1 Ceftriaxone is recommended for various infections, including infective endocarditis, and is not contraindicated in patients with neurological conditions. 1
There is even a case report of a patient with myasthenia gravis who was successfully treated with ceftriaxone for neuroborreliosis, with the antibiotic being well-tolerated despite the underlying myasthenic condition. 2
Antibiotics That ARE Problematic in Myasthenia Gravis
While ceftriaxone is safe, certain other antibiotic classes should be avoided:
- Fluoroquinolones should be avoided as they may trigger or exacerbate myasthenic symptoms. 1, 3
- Aminoglycosides (streptomycin, amikacin, kanamycin) can precipitate or worsen myasthenic weakness. 3
- Macrolide antibiotics are associated with myasthenic exacerbations. 3, 4
Notably, even penicillins (amoxicillin), traditionally considered safe, have been reported to cause acute worsening of myasthenia gravis symptoms in some patients, with exacerbations occurring within days of administration. 5
Clinical Advantages of Ceftriaxone
For serious infections requiring parenteral therapy in myasthenia gravis patients, ceftriaxone offers the advantage of once-daily dosing, which may be beneficial for outpatient management. 1
Key Clinical Caveat
When any new medication is introduced in a patient with myasthenia gravis, close monitoring for possible worsening of muscle weakness is essential, particularly in symptomatic patients with generalized disease who are especially vulnerable to drug-induced exacerbations. 6 However, this general precaution does not make ceftriaxone contraindicated—it simply reflects good clinical practice for this patient population.