Resistance to Ceftriaxone


Editors:

Elham Reshid and Hailemariam Shimelis

Antibiotics are among the safest of drugs, which have had a major impact on life ties associated with surgery and many common infectious diseases. This in turn is, at least in part, responsible for the overprescribing of these agents, which has led to concerns with regard to the increasing incidence of microbialresistance. -threatening infections and morbidiCeftriaxone is a broad spectrum antibiotic released into the market in 1988 for treatment of severe infections or infections caused by multiple resistance strains.

However, nowadays, many species are resistant to ceftriaxone and this has become a concern worldwide, as it is associated with therapeutic failure. According to a study done at Tikur Anbessa Specialized Hospital (TASH),  most of the isolated microorganisms, including among others, E. coli, klebsiella spp, staphylococcus spp, pseudomonas spp, acinobacter spp, and viridans group of streptococcus were resistant to third generation cephalosporins (3GCs).

It was also noted that the amount of ceftriaxone prescribed was considered as one factor contributing to increased rate of resistance. In another study, resistance to ceftriaxone among enterobacter species rose from 10 to 27 % while the amount of ceftriaxone used almost tripled during the study period.

The TASH study also highlighted that ceftraxone was the top drug prescribed among 3GCs and almost all prescriptions of ceftriaxone (98.7%) were issued for empirical therapy. Moreover, it was also found that ceftriaxone use was non-concordant with accepted guidelines in about two third of the cases. This rate was similar to that of Ayder Hospital (64.2%) but significantly higher than that of Dessie referral hospital (46.2%).

In another study conducted at TASH, the point prevalence for ceftriaxone consumption at Internal & Emergency wards was found to be 58%. Twice daily regimen and empirical treatment to suspected infections without culture and sensitivity tests were among the causes for high number of ceftriaxone consumption. According to this study, culture and sensitivity test was not done in73.7% cases and for those done; resistance was noted in 81% of the cases.

The studies carried out at TASH and elsewhere clearly indicate that the widespread use of ceftiaxone could eventually end the usefulness of this antibiotic. It is thus evident that there is a need to develop protocols or implement programs that promote the judicious use and sensible prescriptions of broad spectrum drugs in general and this agent in particular. Even if initial the rapy in the severely ill patient is often started with broad spectrum antibiotics in order to cover the range of possible pathogens, drugs like ceftriaxone should be narrowed down once necessary culture and sensitivity results become available.

Click for pdf here.

References:

www.ncbi.nlm.nih.gov/m/pubmed/1464634/

http://aac.asm.org/content/39/11/2516.full.pdf

Getasew AA, Belayneh KG, Abebe ZB, Jimma LL. (2013). Drug Use evaluation of ceftriaxone in medical ward of Dessie Referral Hospital, North East Ethiopia. International Journal of Basic and Clinical Pharmacology, 2(6): 711 -7

Firehiwot AA, Derbew FB, Abera HB, Hailemichael ZH. (2012). Drug Use Evaluation of Ceftriaxone: The case of Ayder Referral Hospital, Mekelle, Ethiopia. International Journal of Pharmaceutical Sciences and Research, 3(7): 2191 -2195

Frebizu A. (2013). Drug Use Evaluation of Cephalosporins in Internal Medicine Wards of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.

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