Adverse Reaction to Ceftriaxone: How Far Can We Go to exclude an Allergy?

In the pediatric population, cephalosporins are one of the most often prescribed antibiotic groups. Currently, the European Network for Drug Allergy's (ENDA) standardized diagnostic techniques are widely used to diagnose beta lactam allergic reactions, which help physicians to confirm or exclude the allergy.

Here, we report a case of an incorrectly labeled child of allergy to ceftriaxone after presenting a reaction minutes after the administration of the first dose of ceftriaxone. The allergic pathogenesis was suspected based on the clinical data (brief interval between the drug injection and the appearance of symptoms). we performed skin tests, intradermal tests (IDT) for ceftriaxone, which turn out negatives, then we found an alternative drug for the patient to use by testing ceftazidime and amoxicillin and finally, since the symptoms weren’t specific of an allergy reaction and more likely suggesting a vasovagal syncope, we pursued with an intravenous drug provocation test to ceftriaxone, those tests helped us to prove the innocence of ceftriaxone and enabled us to reassure the parents.

Doctors should be mindful of the risks associated with avoiding specific antibiotic classes, particularly beta lactams, which are the most frequently recommended first-line antibiotics for pediatric patients and whose exclusion may complicate the management of certain pathologies. Such an approach may increase the number of infections, have an influence on antimicrobial stewardship, and have negative health economic effects on the public, it is crucial to avoid identifying a child as allergic without first performing an appropriate diagnostic workup.