Local health care provider weighs in on Rocephin concerns amid ADPH investigation

Yahoo

24-01-2025

Jan. 24—The Alabama Department of Public Health is investigating some reports of adverse reactions to injections of the antibiotic ceftriaxone, or Rocephin, but a local health provider said she has seen no serious reactions to the drug in her practice.
The ADPH on Tuesday issued a statement that it is reviewing 11 incidents of adverse reactions to the drug over the last few months and encouraged health care providers to discuss its use with patients and to "have a plan in place to respond to any adverse events." It also requested that providers report any adverse reactions to the drug.
Nurse practitioner Crystal Landrum, who owns Riverside Family Health in Southeast Decatur, said she injects patients with Rocephin two to three times a week and has not witnessed any serious reactions. As recently as Monday, she administered three Rocephin shots to children with ear infections and had "no problems whatsoever."
"I think the most I've ever had was a little redness in the leg and that was probably eight or nine months ago," Landrum said.
Landrum said she typically gives Rocephin to patients with bad bacterial infections and it is mostly used in pediatric cases for ear infections and pneumonia. Teenagers receive the drug for sexually transmitted diseases.
"Some of the cases reviewed have had signs and symptoms compatible with anaphylactic reaction, including hives, pruritis, hypotension, and hypoxia, which have been successfully treated with measures for anaphylaxis," according to ADPH. Anaphylaxis is a severe allergic reaction that must be treated immediately with an injection of epinephrine.
Landrum said she believes anaphylactic reactions to Rocephin are rare, noting that in her 30 years in the medical field — including 18 years as an emergency room nurse — she has never witnessed a single case of anaphylaxis caused by the drug.
"The way you classify the difference is, if they have a rash with it and I have to give a steroid, then that's not anaphylaxis," Landrum said. "But if they have a reaction to it and I have to put them in the hospital or I have to send them to the ER because the reaction is so bad, then that can be considered mild anaphylaxis."
Landrum said 11 anaphylactic reactions in just a few months was unusual.
Local and area hospitals say they are working closely with the ADPH and following their guidelines. North Alabama Medical Center in Florence issued a statement Tuesday saying it was removing Rocephin "out of an abundance of caution" despite no reactions having been reported in its facilities.
Landrum said she does not understand why the hospital is removing the drug since there were no adverse reactions reported.
"It seems a little overkill because ... the ADPH didn't tell us not to use it, they just said to make sure we were monitoring for allergic reactions and to report any allergic reactions," Landrum said. "Removing Rocephin from a hospital, I would say that's huge. That is every major infection, that's some pre-op surgery drugs, so I don't see the research behind that big of a decision."
Landrum said there are substitute IV antibiotic drugs that health facilities can use in place of Rocephin if they do decide to remove it.
The ADPH statement said it has found no causal link between Rocephin and the adverse reactions.
Because of the absence of a causal link, Landrum said the problem may not be from the drug.
"Rocephin comes in a powder, and you have to mix it, and you can either mix it with sodium chloride or lidocaine because the shot burns when you give it," Landrum said. "Depending on what they are mixing it with, the reaction can be with the lidocaine and not the Rocephin. Without having that information on those 11 anaphylaxes, those are some of the things they're going to have to look at; what it was mixed with, whether it was IV (intravenous) or IM (intramuscular), or if it was mixed with saline or lidocaine."
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