Ceftriaxone injection, part of the medication used to treat late musician Mohbad has been responsible for severe and life-threatening adverse reactions as well as deaths in several countries over the past two decades, findings by The Nation have shown.
Lagos Police Commissioner of Police, Idowu Owohunwa’s preliminary report of an ongoing inquiry into the death of Ilerioluwa Oladimeji Aloba aka MohBad indicated that one of the late musician’s friends, Ayobami Sadiq (Spending) had called his own nurse, Ms. Feyisayo Ogedengbe who treated Mohbad with 1 Pack of Ceftriaxone injection; 1 Vial Paracetamol injection, Tetanus Toxoid injection, 1 Vial Procaine Penicillin, 7 ampules of IM Diclofenac, Tincture Iodine, and Needles/Syringes.
Police boss: “Ms Feyisayo administered the Tetanus Toxoid on the arm of MohBad and gave both the Paracetamol and Ceftriaxone injection intravenously; immediately the Ceftriaxone injection was administered, Ms. Feyisayo confirmed that MohBad started vomiting while goose bumps appeared on his face and all over the body.
A 7-page publication by the Registration & Regulatory Affairs (R & R) Directorate of the National Agency for Food and Drug Administration and Control (NAFDAC) on the use of ‘Ceftriaxone 1g powder for solution for injection/infusion’ emphatically asserts that “Consideration should be given to official guidelines on the appropriate use of antibacterial agents.”
Checks indicate that on 6 January 2012, the United States Food and Drug Administration (FDA) had emulated Canadian health authorities by banning the use of certain variants of Ceftriaxone in treating animals and chickens, citing ‘declines in the prevalence of cephalosporin-resistant Salmonella Heidelberg isolates in chicken meat and in humans’.
Several studies and drug reviews presented online by the United States’ National Center for Biotechnology Information which advances science and health by providing access to biomedical and genomic information reflect longstanding deep concerns largely caused by the easy mishandling of Ceftriaxone.
One of the reviews titled ‘Evaluation of the Clinical Use of Ceftriaxone among In-Patients in Selected Health Facilities in Uganda’, published on June 25, 2021, found that Ceftriaxone has a high propensity for misuse because of its high rate of utilization.
“In this study, we aimed at assessing the appropriateness of the clinical utilization of ceftriaxone in nine health facilities in Uganda; using the World Health Organization (WHO) Drug Use Evaluation indicators, we reviewed a systematic sample of 885 patients’ treatment records selected over a three (3)-month period.
“Ceftriaxone, like most cephalosporins, has a high prevalence of inappropriate prescriptions: Ceftriaxone has a high propensity for misuse because it is utilized in high quantities clinically and is prescribed uncontrolled in many countries including Uganda.
“Inappropriate use of antibiotics such as ceftriaxone accelerates the emergence of antimicrobial resistance, increases costs of treatment, affects productivity, and exposes patients to unnecessary side effects, and can also result in death,” it stated.
Acknowledged effectiveness of Ceftriaxone includes its ability to kill some important causative organisms of respiratory tract infections, Haemophilus influenzae, Streptococcus pneumoniae and Klebsiella pneumonia and some strains of Pseudomonas aeruginosa, the bug that causes dangerous hospital infections.
However, another review notes that ceftriaxone can be hard on kidneys to the extent of causing kidney injury as ‘it can bind with calcium ions, producing a poorly soluble ceftriaxone–calcium salt that forms precipitates in the urinary tract, also known as urolithiasis ; although its incidence is relatively rare, ceftriaxone-induced urolithiasis could lead to severe complications, such as acute kidney injury (AKI),” .
In another review dated as far back as August 2012 titled “Adverse events induced by ceftriaxone: a 10-year review of reported cases to Iranian Pharmacovigilance Centre’ showed that studies conducted in Iran pointed to the need for serious caution and expert directions in handling the medication.
“Ceftriaxone was responsible for the highest number of deaths in our database (49 cases). Of 20,877 reports, 1205 (5·8%) were related to ceftriaxone; 357 reports (30%) are categorized as serious including cardiac arrest, anaphylactic and anaphylactoid reactions.
“The high number of serious cases makes it necessary to develop preventive measures for reducing those adverse events. Unlabelled use of the drug (2·9%) is identified as one of the risk factors for adverse events.
“Evaluation of the 1030 intravenous injections of the drug shows that rapid intravenous injection of ceftriaxone is another risk factor. One hundred and sixteen patients (9·6%) had a previous history of allergic reaction to ceftriaxone, penicillin or both.
“We recommend an alternative antibiotic, if possible, in the case of a positive history of allergic reaction to cephalosporins, penicillins and/or other beta-lactam antibiotics.
Under a section titled ‘What is new and conclusion’, it was recommended that “Severe and life-threatening adverse reactions induced by ceftriaxone are of great concern. Rapid intravenous injection, unlabelled use and previous patient history of allergic reactions to cephalosporins or penicillins are risk factors that should be guarded against.”