Baby, Don't Break My Cell Wall

It's been a while since I decided to run my mouth about antibiotics. I figure it’s a day ending in 'Y' and I got to use the Sawz-all so it’s a good day to talk about ceftriaxone. We've talked about, or I've talked about and you've ignored me, like you should, about 1st and 2nd generation cephalosporins. In the same family tradition, the grandchildren of cephalexin and cefadroxil, the 3rd generation works in the beta-lactam business. However, the grandkids have gotten smarter and learned from their elder's mistakes. 

Ceftriaxone is given IV or IM at 1-2g q8-q24 or from 50mg/kg/day for pediatric patients. The long half life is nice as it can be dosed at longer intervals. As a nurse I like this and I’m sure the patients appreciate me not giving them a new infusion every 6-8 hours. It is not removed via dialysis and for patients with liver or kidney problems no more than 2g a day should be given. Normally the max dose is 4g.   It can penetrate the blood brain barrier but does not cross the placenta. It is avoided for treating pseudomonas, enterobacter, or L. Monocytogenes. Serratia and citrobacter develop resistance fairly quickly though it is effective normally. Common uses include diabetic foot ulcers, endocarditis prophylaxis, gonorrhea, and syphilis to name a few. 

Yes, yes, yes. John do you have anything interesting to say? Maybe? An article from 2017 looks at the appropriate, or inappropriate (throw some clothes on please) use of ceftriaxone in a VA ED. First bit that I found was the literature up to that point showed an appropriate use rate of 12-78%. Geez. Do other classes of drugs have this same problem? are 50% of lisinopril prescriptions in appropriate? Are docs giving it out when patients come in with knee pain? Anywho. This article also tracked the increase in ceftriaxone resistance in E. coli which increased for 3%-9% between 2010 and 2014. Another showed only 71% of patients with community acquired bacterial pneumonia got adequate treatment with ceftriaxone when hospitalized. Do you want resistance? Because this is how you get resistance. 

Why? Are people just stuck in their old ways? Is it ignorance? Beats me but it needs to change. I think of very basic examples of appropriate use of everything from medications to minor interventions. Is it appropriate for a patient with a broken arm to have a LP? Probably not needed. The kid with a sore throat? Probably doesn't need a chest x-ray. Patient with a hip fracture in the hospital, do they need neutropenic precautions? Not unless there is something else going on. These may be silly examples however it seems like some people don't understand. I am not throwing stones but, ask the people who would know. Why give inappropriate therapy or interventions to someone when you could quick check with a subject matter expert and ensure the right therapy or intervention was given? I ask a lot of questions, I want to make sure I do the right things and I want to keep other people thinking. Is that the right drug? Is that the right treatment? Not going to question everything but there is a usefulness to questioning decisions. 

Final super duper cool thing I found is ceftriaxone as a possible agent for lung cancers. I love repurposed drugs. We have them already, and especially if they are widely available and not exorbitantly prices, if they work let's try them. It was a small article from 2012 about how ceftriaxone in vitro binds with Aurora B kinase, which causes cell cycle arrest and death if inhibited. It is activated during mitosis so those rapidly dividing cells may be more effected. In animal models it was shown to suppress lung cancer progression. As I said, super duper cool. 

Anyways, I'm rambling and this post probably does not make sense. But, thats ok I. Do I ever make sense? Depends who you ask. Happy Mothers day to all the moms out there and especially my mom. She's a badass in her own right AND a nurse of over 30 years. What a woman. 

Please share this and the podcast and give me feedback! Tell me how much you hate this. Is it tolerable if you have had enough to drink? Tell me that too. Love y'all.

References

Appropriate uses of Ceftriaxone in the Emergency Department of a Veteran's Health Care System from the Journal of Pharmacy Technology in 2017 by Durham et al. 

Ceftriaxone from Antimicrobe.org

Ceftriaxone, an FDA-approved cephalosporin antibiotic, suppresses lung cancer growth by targeting Aurora B from Carcinogenesis September 2012 by Li et al.

Ceftriaxone resistance and inadequacy of initial antibiotic therapy in community onset bacterial pneumonia from Medicine May 2022 by Van Besien et al. 

Image of secondary syphilis cutaneous manifestation from DermNet NZ.