Ceftriaxone-induced hypersensitivity in pregnancy: Insights from a case of variable reactions to different brands

Abstract

Ceftriaxone, a third-generation cephalosporin, is widely used for its broad-spectrum antibacterial activity but poses challenges in managing hypersensitivity reactions, particularly in pregnant patients. This case study explores a 35-year-old woman in her second trimester of a twin pregnancy with a history of gestational diabetes mellitus and pregnancy-induced hypertension. She was referred for a urinary tract infection (UTI) caused by Klebsiella pneumoniae. Initial treatments with erythromycin and sulbactam/cefoperazone were ineffective, leading to the use of ceftriaxone. A skin test revealed severe hypersensitivity to ceftriaxone from one manufacturer ("Brand A") but not to another ("Brand B"). After careful consideration, a 10-day course of parenteral ceftriaxone from Brand B was administered without adverse reactions. The observed variability in hypersensitivity reactions between different brands of ceftriaxone highlights the potential influence of formulation differences on patient tolerance. This underscores the importance of individualized patient assessment, including skin testing necessary, to ensure both safety and efficacy, particularly in high-risk populations such as pregnant patients. This finding emphasizes the necessity for skin testing in pregnant patients where treatment options are limited and both maternal and fetal safety are paramount.