From the FDA Drug Label
This preparation may be administered by intravenous injection, by intravenous infusion, or by intramuscular injection, the preferred method for initial emergency use being intravenous injection. The answer is: Yes, Solumedrol (methylprednisolone) can be given IV for a ceftriaxone reaction, as it can be administered by intravenous injection for emergency use 1.
From the Research
Solumedrol (methylprednisolone) IV can be appropriate for treating a ceftriaxone allergic reaction, particularly for moderate to severe reactions, as supported by the most recent evidence 2. When a patient experiences symptoms like hives, swelling, respiratory distress, or anaphylaxis after ceftriaxone administration, methylprednisolone 1-2 mg/kg IV (typically 125 mg for adults) should be given promptly. This should be administered alongside other immediate interventions such as stopping the ceftriaxone infusion, maintaining the airway, and potentially administering epinephrine (0.3-0.5 mg IM) for anaphylaxis. Diphenhydramine 25-50 mg IV may also be given concurrently. Methylprednisolone works by suppressing the inflammatory response and immune system activation that occurs during an allergic reaction, reducing symptoms and preventing progression.
Key considerations in managing a ceftriaxone allergic reaction include:
- Stopping the ceftriaxone infusion immediately
- Maintaining the airway and ensuring adequate breathing and circulation
- Administering epinephrine for anaphylaxis
- Using antihistamines like diphenhydramine for symptom relief
- Considering the use of corticosteroids like methylprednisolone for their anti-inflammatory effects, although their role is still being studied 2
- Monitoring the patient closely for at least 4-6 hours for potential biphasic reactions
- Documenting the ceftriaxone allergy in the patient's medical record
- Selecting an alternative antibiotic from a different class for continued treatment of the underlying infection
It's crucial to prioritize the patient's safety and take immediate action to manage the allergic reaction, as severe reactions can be life-threatening 3, 4. The use of epinephrine, antihistamines, and corticosteroids should be guided by the severity of the reaction and the patient's overall condition, with the most recent evidence suggesting a beneficial effect of early epinephrine and antihistamine use 2.