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Injectable ceftriaxone is widely used in African hospitals for both curative and preventive purposes due to its effectiveness, broad spectrum of action, and pharmacokinetic properties, despite growing concerns about antibiotic resistance.

Why is ceftriaxone used so much?

Curative use

Ceftriaxone is an antibiotic from the third-generation cephalosporin family. It is particularly effective in the treatment of many severe bacterial infections.

Broad spectrum of action: It acts against a wide variety of gram-positive and gram-negative bacteria, making it useful for treating serious infections, including when the pathogen has not yet been identified.

Versatility: It is effective against a variety of infections including meningitis, septicemia (blood infection), severe pneumonia, intra-abdominal infections, osteoarticular infections, and genital infections such as gonorrhea.

Single daily administration: Its prolonged effectiveness allows for a single daily injection, which simplifies treatment and reduces the workload for caregivers, especially in hospitals with limited resources.

Security profile: It has a good security profile and is relatively affordable, making it a common choice in many low- and middle-income countries.

Preventive use

Perioperative prophylaxis: It is often used to prevent postoperative infections, especially for patients undergoing high-risk surgical procedures. This is crucial in environments where the risk of hospital-acquired (hospital-related) infections is high.

Infections in immunocompromised patients: In some cases, it is used for prophylaxis in patients who are at increased risk of bacterial infections due to a weakened immune system.

Disadvantages and issues raised

Although ceftriaxone is very effective, its widespread use, including its inappropriate use, is causing serious problems in African hospitals:

Antibiotic resistance: Overdiagnosis and the misuse of ceftriaxone are major factors in the development of bacterial resistance. Several studies in sub-Saharan Africa have reported a high rate of inappropriate ceftriaxone use, which is fuelling this phenomenon.

Impact on bacterial flora: The abusive use of antibiotics, including ceftriaxone, can promote the proliferation of resistant bacteria and compromise the future effectiveness of treatment.

Lack of surveillance: There is a lack of organized data on the appropriate use of antibiotics in sub-Saharan Africa. The lack of surveillance for antimicrobial resistance makes it difficult to develop relevant treatment guidelines.

Pressure on resources: Although relatively affordable, its excessive use can weigh on already limited health budgets.

Conclusion

Ceftriaxone is an indispensable therapeutic tool in African hospitals because of its potency, its broad spectrum of action and its ease of use. However, frequent and sometimes inappropriate use for curative and preventive treatments promotes antibiotic resistance. To maintain its effectiveness, a more rational use is needed, based on antibiotic management programs and on the continuous updating of treatment protocols.