{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T10:27:12Z","timestamp":1792405632614,"version":"4.4.0"},"reference-count":20,"publisher":"The Pediatric Pharmacy Association","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018]]},"abstract":"<jats:p>Several medications have been shown to cause disulfiram-like reactions in patients concomitantly exposed to ethanol, including specific cephalosporin antibiotics that possess a methylthiotetrazole substituent. Within the cephalosporin class, there are few reports of disulfiram-like reactions with ceftriaxone. This case report is the first to involve a pediatric patient, and it describes a mild but likely disulfiram-like reaction manifesting as facial flushing in an 8-year-old male upon receiving a ceftriaxone infusion preceded by a dose of prednisolone elixir (5% ethanol by volume) for presumed community-acquired pneumonia thought to be complicated by an asthma exacerbation. The patient's flushing resolved with intravenous diphenhydramine, did not reappear, and was diagnosed as an allergy to ceftriaxone. Upon further evaluation, a hypersensitivity reaction was considered unlikely, and the allergy history was revised. The patient's antibiotic treatment was switched to azithromycin without steroids, and he had no further issues. This case suggests there is benefit in increased monitoring of pediatric patients receiving certain cephalosporins along with alcohol-containing medications, and it demonstrates how disulfiram reactions can easily be misinterpreted as hypersensitivity reactions. Aside from just alcohol-cephalosporin interactions, this case underscores the need for general vigilance when using alcohol-containing drug preparations in pediatric patients in an effort to prevent adverse effects and potential drug interactions.<\/jats:p>","DOI":"10.5863\/1551-6776-23.2.168","type":"journal-article","created":{"date-parts":[[2018,4,25]],"date-time":"2018-04-25T15:12:53Z","timestamp":1524669173000},"page":"168-171","source":"Crossref","is-referenced-by-count":5,"title":["Disulfiram-like Reaction Involving Ceftriaxone in a Pediatric Patient"],"prefix":"10.5863","volume":"23","author":[{"given":"Stephen M.","family":"Small","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel S.","family":"Bacher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheridan A.","family":"Jost","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3883","reference":[{"issue":"S17","key":"i1551-6776-23-2-168-b1","series-title":"J Stud Alcohol Drugs Suppl","first-page":"79","article-title":"Pharmacotherapy of alcohol use disorders: seventy-five years of progress","volume":"75","year":"2014","unstructured":"Zindel\n              LR\n            , KranzlerHR.\n          Pharmacotherapy of alcohol use disorders: seventy-five years of progress. J Stud Alcohol Drugs Suppl. 2014;75(S17):79\u201388."},{"issue":"4","key":"i1551-6776-23-2-168-b2","series-title":"Indian J Pharmacol","first-page":"399","article-title":"Unexpected death due to cefuroxime-induced disulfiram-like reaction","volume":"45","year":"2013","unstructured":"Dong\n              H\n            , ZhangJ, RenL, \n          et al. Unexpected death due to cefuroxime-induced disulfiram-like reaction. Indian J Pharmacol. 2013;45(4):399\u2013400."},{"issue":"4","key":"i1551-6776-23-2-168-b3","series-title":"Am J Forensic Med Pathol","first-page":"343","article-title":"Sudden death due to metronidazole\/ethanol interaction","volume":"17","year":"1996","unstructured":"Cina\n              SJ\n            , RussellRA, ConradiSE.\n          Sudden death due to metronidazole\/ethanol interaction. Am J Forensic Med Pathol. 1996;17(4):343\u2013346."},{"issue":"12","key":"i1551-6776-23-2-168-b4","series-title":"Biochem Pharmacol","first-page":"1933","article-title":"The effects of cephem antibiotics and related compounds on the aldehyde dehydrogenase in rat liver mitochondria","volume":"36","year":"1987","unstructured":"Kamei\n              C\n            , SugimotoY, TasakaK.\n          The effects of cephem antibiotics and related compounds on the aldehyde dehydrogenase in rat liver mitochondria. Biochem Pharmacol. 1987;36(12):1933\u20131939."},{"issue":"9","key":"i1551-6776-23-2-168-b5","series-title":"Methods Find Exp Clin Pharmacol","first-page":"595","article-title":"Ethanol-cephalosporin antibiotic interactions: an animal model for the detection of disulfiram (Antabuse)-like effects","volume":"5","year":"1983","unstructured":"Fromtling\n              RA\n            , GadebuschHH.\n          Ethanol-cephalosporin antibiotic interactions: an animal model for the detection of disulfiram (Antabuse)-like effects. Methods Find Exp Clin Pharmacol. 1983;5(9):595\u2013600."},{"issue":"5","key":"i1551-6776-23-2-168-b6","series-title":"Antimicrob Agents Chemother","first-page":"731","article-title":"Ceftriaxone therapy of bone and soft tissue infections in hospital and outpatient settings","volume":"23","year":"1983","unstructured":"Eron\n              LJ\n            , ParkCH, HixonDL, \n          et al. Ceftriaxone therapy of bone and soft tissue infections in hospital and outpatient settings. Antimicrob Agents Chemother. 1983;23(5):731\u2013737."},{"issue":"4C","key":"i1551-6776-23-2-168-b7","series-title":"Am J Med","first-page":"84","article-title":"Clinical adverse effects during ceftriaxone therapy","volume":"77","year":"1984","unstructured":"Moskovitz\n              BL.\n            \n          \n          Clinical adverse effects during ceftriaxone therapy. Am J Med. 1984;77(4C):84\u201388."},{"issue":"4","key":"i1551-6776-23-2-168-b8","series-title":"Geriatrics","first-page":"70","article-title":"Disulfiram-like reactions rare with ceftriaxone","volume":"47","year":"1992","unstructured":"Billstein\n              SA\n            , SudolTE.\n          Disulfiram-like reactions rare with ceftriaxone. Geriatrics. 1992;47(4):70."},{"issue":"2","key":"i1551-6776-23-2-168-b9","series-title":"Int Surg","first-page":"142","article-title":"Cephalosporin induced disulfiram-like reaction: a retrospective review of 78 cases","volume":"99","year":"2014","unstructured":"Ren\n              S\n            , CaoY, ZhangX, \n          et al. Cephalosporin induced disulfiram-like reaction: a retrospective review of 78 cases. Int Surg. 2014;99(2):142\u2013146."},{"issue":"2","key":"i1551-6776-23-2-168-b10","series-title":"Behav Genet","first-page":"131","article-title":"Alcohol and aldehyde dehydrogenase polymorphisms and alcoholism","volume":"23","year":"1993","unstructured":"Thomasson\n              HR\n            , CrabbDW, EdenbergHJ, \n          et al. Alcohol and aldehyde dehydrogenase polymorphisms and alcoholism. Behav Genet. 1993;23(2):131\u2013136."},{"issue":"3","key":"i1551-6776-23-2-168-b11","series-title":"Jpn J Pharmacol","first-page":"303","article-title":"Effects of beta-lactam antibiotics and N-methyltetrazolethiol on the alcohol-metabolizing system in rats","volume":"45","year":"1987","unstructured":"Matsubara\n              T\n            , OtsuboS, OgawaA, \n          et al. Effects of beta-lactam antibiotics and N-methyltetrazolethiol on the alcohol-metabolizing system in rats. Jpn J Pharmacol. 1987;45(3):303\u2013315."},{"issue":"1","key":"i1551-6776-23-2-168-b12","series-title":"Alcohol Clin Exp Res","first-page":"27","article-title":"The effect of 5,5\u2032-dithiobis(1-methyltetrazole) on cytoplasmic aldehyde dehydrogenase and its implications for cephalosporin-alcohol reactions","volume":"10","year":"1986","unstructured":"Kitson\n              TM.\n            \n          \n          The effect of 5,5\u2032-dithiobis(1-methyltetrazole) on cytoplasmic aldehyde dehydrogenase and its implications for cephalosporin-alcohol reactions. Alcohol Clin Exp Res. 1986;10(1):27\u201332."},{"issue":"4","key":"i1551-6776-23-2-168-b13","series-title":"Eur J Drug Metab Pharmacokinet","first-page":"269","article-title":"Disposition of ceftriaxone in hepatopathic goats following single-intramuscular dosing","volume":"38","year":"2013","unstructured":"Sar\n              TK\n            , MandalTK, PatraPH, \n          et al. Disposition of ceftriaxone in hepatopathic goats following single-intramuscular dosing. Eur J Drug Metab Pharmacokinet. 2013;38(4):269\u2013273."},{"issue":"2","key":"i1551-6776-23-2-168-b14","series-title":"Br J Clin Pharmacol","first-page":"213","article-title":"Concentration-time profiles of ethanol and acetaldehyde in human volunteers treated with the alcohol-sensitizing drug, calcium carbimide","volume":"25","year":"1988","unstructured":"Jones\n              AW\n            , NeimanJ, HillbomM.\n          Concentration-time profiles of ethanol and acetaldehyde in human volunteers treated with the alcohol-sensitizing drug, calcium carbimide. Br J Clin Pharmacol. 1988;25(2):213\u2013221."},{"issue":"6","key":"i1551-6776-23-2-168-b15","series-title":"Pediatrics","first-page":"975","article-title":"Estimated blood alcohol concentrations for child and adolescent drinking and their implications for screening instruments","volume":"132","year":"2009","unstructured":"Donovan\n              JE.\n            \n          \n          Estimated blood alcohol concentrations for child and adolescent drinking and their implications for screening instruments. Pediatrics. 2009;132(6):975\u2013981."},{"key":"i1551-6776-23-2-168-b16","series-title":"Disulfiram [package insert]","year":"2016","unstructured":"Rising Pharmaceutical, Inc.\n          \n          Disulfiram [package insert]. Allendale, NJ: Rising Pharmaceutical, Inc; 2016."},{"issue":"6","key":"i1551-6776-23-2-168-b17","series-title":"Br J Clin Pharmacol","first-page":"551","article-title":"The effect of beta-adrenoceptor agonists and antagonists on gastric emptying in man","volume":"10","year":"1980","unstructured":"Rees\n              MR\n            , ClarkRA, HoldsworthCD, \n          et al. The effect of beta-adrenoceptor agonists and antagonists on gastric emptying in man. Br J Clin Pharmacol. 1980;10(6):551\u2013554."},{"issue":"2","key":"i1551-6776-23-2-168-b18","series-title":"Antimicrob Agents Chemother","first-page":"248","article-title":"Single-dose pharmacokinetics of ceftriaxone in infants and young children","volume":"21","year":"1982","unstructured":"Schaad\n              UB\n            , StoeckelK.\n          Single-dose pharmacokinetics of ceftriaxone in infants and young children. Antimicrob Agents Chemother. 1982;21(2):248\u2013253."},{"issue":"7","key":"i1551-6776-23-2-168-b19","series-title":"J Clin Pharmacol","first-page":"665","article-title":"Diphenhydramine: pharmacokinetics and pharmacodynamics in elderly adults, young adults, and children","volume":"30","year":"1990","unstructured":"Simons\n              KJ\n            , WatsonWT, MartinTJ, \n          et al. Diphenhydramine: pharmacokinetics and pharmacodynamics in elderly adults, young adults, and children. J Clin Pharmacol. 1990;30(7):665\u2013671."},{"issue":"5","key":"i1551-6776-23-2-168-b20","series-title":"Clin Pharmacol Ther","first-page":"521","article-title":"Diphenhydramine and the calcium carbimide-ethanol reaction: a placebo-controlled clinical study","volume":"39","year":"1986","unstructured":"Stowell\n              A\n            , JohnsenJ, RipelA, \n          et al. Diphenhydramine and the calcium carbimide-ethanol reaction: a placebo-controlled clinical study. Clin Pharmacol Ther. 1986;39(5):521\u2013525."}],"container-title":["The Journal of Pediatric Pharmacology and Therapeutics"],"original-title":[],"link":[{"URL":"https:\/\/jppt.kglmeridian.com\/view\/journals\/jppt\/23\/2\/article-p168.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/meridian.allenpress.com\/jppt\/article-pdf\/23\/2\/168\/1719257\/1551-6776-23_2_168.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/jppt.kglmeridian.com\/downloadpdf\/journals\/jppt\/23\/2\/article-p168.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/jppt.kglmeridian.com\/downloadpdf\/journals\/jppt\/23\/2\/article-p168.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T00:34:07Z","timestamp":1747355647000},"score":1,"resource":{"primary":{"URL":"https:\/\/jppt.kglmeridian.com\/view\/journals\/jppt\/23\/2\/article-p168.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018]]},"references-count":20,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.5863\/1551-6776-23.2.168","relation":{},"ISSN":["1551-6776"],"issn-type":[{"value":"1551-6776","type":"print"}],"subject":[],"published":{"date-parts":[[2018]]}}}