Ceftriaxone (brand name: Rocephin) is a third-generation beta-lactam in the cephalosporin class of antibiotics. It is similar in action to penicillins, inhibiting bacterial cell-wall synthesis, and, as such, is used in microbes that have a cell wall (unlike mycoplasmas, for instance, that are cell-wall-deficient). It is commonly used to treat Lyme disease, but is also used for bacterial septicemia and meningitis, genitourinary infections, skin infections, acute bacterial otitis media, lower respiratory tract infections, intra-abdominal infections, and sometimes for surgical prophylaxis. Adverse side-effects of ceftriaxone include changes in white blood cell counts, diarrhea, and rash.
A Painful Inflammatory Lesion on the Dorsum of the Hand of a Patient With Rheumatoid Arthritis Treated With Methotrexate. Clin Infect Dis (2014) 59 (6): 903.
The case of an elderly woman with rheumatoid arthritis, treated with methotrexate, who developed an Acrodermatitis chronica atrophicans (ACA) lesion on the dorsal side of her hand is described. ACA is a known skin manifestation of late stage Lyme disease, occurring months to years after infection, and can resemble morphea scleroderma lesions. Although the patient couldn’t recall a tick bite, she was found positive for Lyme disease and treated with IV ceftriaxone, which resulted in ACA resolution. While ACA can also present with peripheral neuropathy, lymphadenopathy and fibrotic nodules over joints can lead to misdiagnosis. The authors conclude by stating, “…we cannot exclude that long-term methotrexate treatment and the history of axillary lymph node dissection may have induced this late local dissemination.”
Ceftriaxone therapy of chronic inflammatory arthritis. A double-blind placebo controlled trial. Arch Intern Med. 1990 Aug;150(8):1677-82.
In a placebo-controlled, double-blind study of 60 patients with inflammatory arthritis – rheumatoid arthritis (RA), psoriatic arthritis (PsA), vasculitis, and undifferentiated connective tissue disease (UCTD) – who were positive for Lyme disease (borrelia burgdorferi), patients were randomized to be in one of two study arms to either receive an inactive placebo or the antibiotic, ceftriaxone, 2 grams/day, intravenously for 2 weeks. Nearly half of the antibiotic group (19/40 patients) experienced improvement as compared with the placebo group (2/20 patients), who were later able to elect to receive ceftriaxone therapy. Of 58 patients who were treated with IV ceftriaxone, 27 were notably improved at follow-up, 13-24 months later, and responses were seen in all forms of arthritis (RA 5/12, PsA 5/8, vasculitis 3/5, and UCTD 14/33). Of these 27 patients, 16 experienced arthritis worsening between 6-18 months post-treatment. The authors concluded that patient response didn’t correlate with either disease duration or Lyme antibody titers, but whether or not patients had noted improvements to oral antibiotics prior to the study. While side-effects were frequent with nearly a third of the ceftriaxone-treated patients (29/60) experiencing diarrhea or acute allergic reactions (9/58), the authors speculate as to the chronic persistence of the infection underlying the inflammatory arthritis and call for further study of the effectiveness of antibiotic therapy in the various forms of chronic arthritis.