cephalosporins in renal insufficiency

Q: Which of the following cephalosporins does not require adjustment in renal insufficiency? (select one)

A) Cefazolin

B) Cefuroxime

C) Ceftriaxone

D) Cefepime

E) Ceftaroline

Answer: C

There are five generations of cephalosporins. All cephalosporins require some level of dose adjustment in renal insufficiency, and in patients on hemodialysis (HD) or continuous renal replacement therapy (CRRT) except ceftriaxone. 

Clinicians should remember one caveat of ceftriaxone. A fatal reaction may occur due to calcium-ceftriaxone precipitates in the organs, particularly lungs and kidneys. This can be more pronounced in neonates. Ceftriaxone should not be mixed with any calcium-containing product like Ringer's or Hartmann's solutions, or parenteral nutrition. Similarly, should be avoided as an infusion from the same lines where calcium-containing products are being infused.

#pharmacology

Reference:

1. Lamb HM, Ormrod D, Scott LJ, Figgitt DP. Ceftriaxone: an update of its use in the management of community-acquired and nosocomial infections. Drugs. 2002;62(7):1041-89. doi: 10.2165/00003495-200262070-00005. PMID: 11985490.

2. Klein NC, Cunha BA. Third-generation cephalosporins. Med Clin North Am 1995; 79:705.