Cephalosporins: How Vital Are They in a Hospitalist ’s Toolkit?

Case A 57-year-old female with a history of hypertension and diabetes mellitus presented to the emergency department with complaints of chills, fever, and productive cough progressively worsening over the last five days. A physical exam revealed a well-nourished woman with mild respiratory distress and was remarkable for rhonchi heard on auscultation at the left lung base. Her blood pressure was 124/73 mm Hg, heart rate was 112 beats per minute, respiratory rate was 24 breaths per minute, and temperature was 101.2 Fahrenheit. Lab work revealed leukocytosis with bandemia. A chest X-ray reported an infiltrate in the lower lobe of the left lung. She was admitted to the hospital for sepsis secondary to left lower lobe community-acquired pneumonia and started on the third-generation cephalosporin ceftriaxone 2 g intravenously, and oral azithromycin 500 mg daily. Subsequently, the patient developed right upper quadrant abdominal pain, and ultrasound revealed biliary tract sludge. Here are key clinical questions to consider: What is most likely the cause of the patient’s abdominal pain?  Dr. Gujarathi Ceftriaxone is one of the most used third-generation cephalosporins in the hospital setting. It can bind to the calcium in bile, forming ceftriaxone crystals in the biliary tract and leading to the syndrome called biliary pseudolithiasis,1 which can present as biliary colic. Most cases are self-resolving with the discontinuation of ceftriaxone. Misdiagnosis of this condition can l...
Source: The Hospitalist - Category: Hospital Management Authors: Tags: Critical Care Drug Therapy Key Clinical Questions Source Type: research