Three Cases of Hemodialysis Patients Receiving High-Dose Ceftriaxone: Serum Concentrations and Its Neurotoxicity

INTRODUCTION C eftriaxone (CTRX) is a third-generation cephalosporin widely used to treat common infections such as pneumonia and urinary tract infections. The therapeutic dose is usually 1 to 2 g/d administered i.v. and can be increased up to 4 g/d for severe infections. Because CTRX is excreted via the biliary and the urine, patients with renal failure require no adjustment in dosage. However, in cases of end-stage renal disease (ESRD), dose reduction of CTRX is recommended because of delayed clearance. Recently, it has been reported that CTRX showed severe neurotoxicity in patients with ESRD or renal insufficiency, but no reports have discussed the association between the serum concentration of CTRX and its neurotoxicity. 9 Here, we report 3 cases of ESRD patients administered high-dose CTRX; 2 patients showed neurotoxicity, whereas the other patient showed no side effects. We measured serum concentrations of CTRX in these 3 patients and reviewed the relationship between CTRX serum concentration and neurotoxicity.