Ceftrixone-Ringer’s Deadly Reaction
Written by Prince Assandoh-Mensah in 2017
Administration of different Intravenous (IV) medications through the same IV cannular is a common act found among health professionals in most settings. This is usually done without a critical look at the effect the drugs may have on each other.
Simultaneous administration of IV Ciprofloxacin and IV Metronidazole is quite common in the treatments of severe gastrointestinal infections whereas simultaneous administration of an intravenous infusions such as Ringers Lactate after other IV medications is more like a routine.
The Big Question is, ” Could any of these combinations have any clinically fatal interactions?”
Today, we will look at one of such instances… Ceftriaxone -Calcium Interaction
Ceftriaxone for injection, a broad-spectrum antibiotic, has been found to precipitate (form crystals) when combined with calcium containing products such as Ringer’s Lactate. Such combination increases the risk of lethal precipitates forming in the lungs and kidneys, especially in Neonates, and eventually resulting in death.
This literally suggests that, combining Ceftriaxone and Ringer’s Lactate or other intravenous calcium containing products can have a fatal consequence on your patients.
CLINICAL RECOMMENDATIONS
1. Do not mix or reconstitute Ceftriaxone with Calcium- Containing infusions such as Ringer’s Lactate.
2. It is best to avoid sequential administration of Ceftriaxone and calcium containing infusions such as Ringer’s Lactate. However, in unlikely situations, the IV line must be thoroughly flushed in between infusions with a compatible fluid before sequential administration can be done.
3. Ceftriaxone must not be administered simultaneously with intravenous Calcium containing solutions through Y-site.
4. Ceftriaxone and Calcium Combination is CONTRAINDICATED in NEONATES (28days or below). Do NOT use or serve Ceftriaxone in NEONATES if they are receiving (or are expected to receive) any calcium containing intravenous fluid.
REFERENCES
https://www.medpagetoday.com/pediatrics/generalpediatrics/6661
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2dd1be9e-74cc-48e8-bf02-f34a78d80fda
