Ceftriaxone-induced Encephalopathy: A Pharmacokinetic Approach
  • Laurent Jadot
    Unité de Soins Intensifs, Centre Hospitalier Chrétien, Liege, Belgium
  • Aurelie Judong
    Service des Urgences, Centre Hospitalier Chrétien, Liege, Belgium
  • Jean-Luc Canivet
    Unité de Soins Intensifs, Centre Hospitalier Chrétien, Liege, Belgium
  • Noel Lorenzo Villalba
    Service de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasboug, Strasbourg, France
  • Pierre Damas
    Service de Soins Intensifs, Centre Hospitalier Universitaire de Liege, Liege, Belgium


Encephalopathy, ceftriaxone, cerebrospinal fluid (CSF) concentration



We report a case of ceftriaxone-induced encephalopathy correlated with high cerebrospinal fluid concentration. Neurotoxicity of cephalosporin is increasingly reported, especially regarding fourth-generation cephalosporins. The factors influencing the corticospinal fluid (CSF) concentration are plasma concentration, liposolubility, ionization, molecular weight, protein binding and efflux. In our patient, high levels of ceftriaxone (27.9 mg/l) were found in the CSF. β-lactam associated neurotoxicity is mainly related to similarities between GABA and β-lactam ring. Because of disparate CSF/plasma ratio and blood-brain barrier efflux among patients, plasmatic drug monitoring probably cannot be used as a surrogate of CSF concentration. This is, as we know, the first case of described ceftriaxone-induced encephalopathy associated with an objective excessive cerebrospinal concentration.





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Published: 2021-11-05
Issue: 2021: Vol 8 No 11 (view)

How to cite:
Jadot L, Judong A, Canivet J-L, Lorenzo Villalba N, Damas P. Ceftriaxone-induced Encephalopathy: A Pharmacokinetic Approach. EJCRIM 2021;8 doi:10.12890/2021_003011.

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