title: Ceftriaxone-induced hemolysis in a child with Lyme arthritis: a case for antimicrobial stewardship.
abstract: Guidelines for the treatment of Lyme arthritis were published by the Infectious Diseases Society of America in 2006 and recommended oral doxycycline for initial therapy. We report here the case of a young girl treated with intravenous ceftriaxone who subsequently developed drug-induced autoimmune hemolytic anemia and renal failure. Her severe sequelae highlight the importance of antimicrobial stewardship. We review here the goals of antimicrobial stewardship and several strategies for achieving them. In addition, we briefly discuss the rare adverse drug event experienced by our patient.
authors.affiliation: Division of Infectious Diseases, Children's Hospital of The King's Daughters and Eastern Virginia Medical School, Norfolk, VA 23508, USA. boggssr@chkd.org
authors.forename: Sarah R
authors.initials: SR
authors.lastname: Boggs
authors.forename: Kenji M
authors.initials: KM
authors.lastname: Cunnion
authors.forename: Reem H
authors.initials: RH
authors.lastname: Raafat
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000503:physiopathology / Q000628:therapy; D000743:Anemia, Hemolytic / Q000139:chemically induced* / Q000503:physiopathology / Q000628:therapy; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001774:Blood Chemical Analysis; D001803:Blood Transfusion / Q000379:methods; D002443:Ceftriaxone / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006461:Hemolysis / Q000187:drug effects; D006801:Humans; D007673:Kidney Cortex Necrosis / Q000139:chemically induced* / Q000503:physiopathology / Q000628:therapy; D007677:Kidney Function Tests; D008193:Lyme Disease / Q000175:diagnosis / Q000188:drug therapy*; D008775:Methylprednisolone / Q000627:therapeutic use; D020127:Recovery of Function; D006435:Renal Dialysis / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002443:Ceftriaxone; D008775:Methylprednisolone