Cross-reaction between ceftizoxime and ceftriaxone inducing autoimmune hemolytic anemia in children: a case report

Published on Jun. 29, 2026Total Views: 46 times Total Downloads: 9 times Download Mobile

Author: LI Wen ¹ LI Gen ¹ JIANG Yongxian ¹ HU Siqi ¹  ZHANG Bo ²

Affiliation: 1.Department of Pharmacy, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu 610041, China 2.Department of Pharmacy, Yibin Second Hospital of Traditional Chinese Medicine, Yibin 644000, Sichuan Province, China

Keywords: Ceftizoxime Ceftriaxone Autoimmune hemolytic anemia Cross-reaction Adverse reactions

DOI: 10.12173/j.issn.1005-0698.202511010

Reference: Li W, Li G, Jiang YX, et al. Cross-reaction between ceftizoxime and ceftriaxone inducing autoimmune hemolytic anemia in children: a case report[J]. Chinese Journal of Pharmacoepidemiology, 2026, 35(6): 705-709. DOI: 10.12173/j.issn.1005-0698.202511010.[Article in Chinese]  Copied

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Abstract

This report describes the diagnosis and treatment of a case of autoimmune hemolytic anemia (AIHA) induced by cross-reaction between ceftizoxime and ceftriaxone in a child. The patient, a 5-year-old male, received ceftizoxime 825 mg, ivd, q8h combined with azithromycin 165 mg, po, qd for anti-infective therapy due to community-acquired pneumonia. On day 5 of treatment, systemic rash, hematuria, and decreased hemoglobin levels after infusion. Laboratory tests indicated severe hemolytic anemia, with a positive direct antiglobulin test, leading to a diagnosis of drug-induced AIHA. Hemolytic symptoms resolved after discontinuation of the suspected drug and symptomatic supportive therapy. Due to unresolved pneumonia, ceftriaxone was administered for anti-infective treatment, but allergic reactions and worsening acute hemolysis occurred rapidly during infusion, with hemoglobin dropping to 33 g·L^-1. The drug was immediately discontinued, and methylprednisolone sodium succinate, blood transfusion, and three plasma exchange treatments were administered, resulting in clinical improvement. Naranjo's Assessment Scale was used to evaluate association, with both ceftizoxime and ceftriaxone demonstrating "likely associated" correlations with AIHA. This case suggests that when a cephalosporin induces AIHA, the use of that drug and other cephalosporins with identical side-chain structures should be avoided.

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References

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