İlk doz seftriakson enjeksiyonu sonrası anafilaksi

Abstract

A An na ap ph hy yl la ax xi is s a af ft te er r t th he e f fi ir rs st t d do os se e o of f c ce ef ft tr ri ia ax xo on ne e i in nj je ec ct ti io on n A Al li i E Er rt tu u¤ ¤ A Ar rs sl la an nk kö öy yl lü ü, , S Se em ma an nu ur r K Ku uy yu uc cu u* *, , S Si ib be el l B Ba al lc c› ›* ** *, , Y Yu us su uf f U Us st ta a* ** ** * IntroductionCeftriaxone is an antibiotic from the group of third-generation cephalosporins used for treatment of bacterial infections. While the incidence of allergic skin reactions related to ceftriaxone is between 1% and 3%, the incidence of anaphylaxis is lower (1). Although ceftriaxone is a frequently used antibiotic for treatment of pediatric patients, only one case of anaphylaxis occuring after the first dose of ceftriaxone has been reported in the literature (2).Herein we report a case of anaphlaxis after the first dose of ceftriaxon. Case reportA two years old male patient presented to the emergency department with fever, vomiting and abdominal pain. Personal and familial history revealed no drug allergy, atopic disease or previous use of beta-lactam antibiotics. The family started to give the patient oral cefuroxime axetyl treatment for pharyngitis.Laboratory investigations were as follows: white blood cells 22811/mm 3 , 80% segmented leucocytes, 14% lymphocytes, 6% monocytes on peripheral blood smear and CRP: 28.9 mg/L. Bacteremia was considered in the patient because of fever, leucocytosis, "shift to the left" on peripheral blood smear and high CRP. Blood culture, urine culture and urinalysis were performed.Afterwards, 500 mg ceftriaxone containing active ingredient was reconstructed with water for injection supplied with the drug by emergency department nurse and diluted to 20 cc with 0.9 % NaCl (25 mg/cc). The solution reconstructed was attached to the infusion pump to be administered in 30 minutes (1.5 mg/kg/minute). Approximately one minute after intravenous infusion of ceftriaxone was started, anaphylactic shock developed accompanied by flushing, respiratory arrest, cyanosis, circulatory failure and hypotension. Positive pressure ventilation with baloon mask was administered to the patient who had a apical heart beat of 180/minute and capillary refill time of more than 2 seconds. 0.01 ml/kg (1:1000) adrenaline was given subcutaneously. 1 mg/kg pheniraminemaleat, 1 mg/kg ranitidine and 0.6 C Ca as se e R Re ep po or rt t S Su um mm ma ar ry yCeftriaxone is a third-generation cephalosporin used for the treatment of bacterial infections. In the literature there is only one pediatric case report of anaphylaxis after first exposure to ceftriaxone. Herein we report a 2 years old boy who developed anaphylaxis after receiving the first intravenous injection of ceftriaxone. Clinicians should be aware of the risk of anaphylaxis after the first dose of ceftriaxone. (Turk Arch Ped 2011; 46: 79-80)

Cephalosporin Antibiotics and Antibiotic Rezistance in Three Decades

“…Direk Coombs testini pozitif yapabilir, hemolitik anemilere neden olabilir; hematüri de yapabilir. Anafilaksi riski vardır (8) . Çocuklarda az sayıda da olsa da anafilaksi vakaları bilinmektedir.…”