The National Adverse Drug Reaction Monitoring Center after more than half a year of comprehensive systematic evaluation, ceftriaxone sodium rational use of the benefits clearly outweigh the risks; in the adverse drug reactions or events reported in the phenomenon of irrational use of drugs widely exists, irrational use of drugs makes the risk factor of drug use increased. For this reason, the State Food and Drug Administration recently dedicated to the clinical irrational use of the drug to warn. Typical case] The patient, female, 17 years old, came to the hospital for gastrointestinal type cold and was given ceftriaxone sodium 2g intravenously after a negative ceftriaxone sodium skin test. At 30ml, she developed chest tightness, shortness of breath, cyanosis, wet and cold skin, faint consciousness, rapid pulse, undetectable blood pressure, and a large number of dry and wet stalls could be heard in both lungs at 112 beats/min, with low and dull heart sounds. Ceftriaxone sodium was immediately discontinued and symptomatic treatment was given, and the self-conscious symptoms improved after 10 minutes. [Expert analysis] Ceftriaxone sodium is indicated for serious infections caused by sensitive gram-negative bacilli and partially sensitive gram-positive cocci, such as respiratory tract infection, sepsis, abdominal infection, pyelonephritis, pelvic inflammatory disease, bone and joint infection, skin and soft tissue infection, central nervous system infection, etc. The National Adverse Drug Reaction Monitoring Center case report database shows that the use of drugs with super indications in serious cases accounts for about 10% of the total number of serious cases reported. Typical case] A child, male, 4 years old, was given ceftriaxone sodium 2g and dexamethasone 2mg in 5% glucose sodium chloride 250ml intravenously for bronchitis. 1 minute later, the child became irritable, runny, spitting white sputum and blue lips, the infusion was closed immediately and emergency measures were taken. 30 minutes later, the resuscitation was ineffective. Expert analysis] The drug instruction of ceftriaxone sodium clearly indicates that the daily dose of intravenous administration for children is 20~80mg/kg (body weight). The case report database of the National Center for Adverse Drug Reaction Monitoring shows that some pediatric patients have overdose. Typical case] The patient, female, 60 years old, went to the village health clinic with upper respiratory tract infection, cough, chest tightness and generalized pain, and was given ceftriaxone sodium 4g, dexamethasone 5mg, ribavirin 600mg mixed with 0.9% sodium chloride injection 500ml intravenously. About 20 minutes later, the patient suddenly felt dyspnea, panic, chest tightness, followed by cardiac arrest, and died after resuscitation. Expert analysis] The drug instruction of ceftriaxone sodium clearly indicates that the product should not be mixed with other drugs due to the possible incompatibility between drugs, and should be used separately when combined with other drugs. The case report database of National Adverse Drug Reaction Monitoring Center shows that there are serious cases in which ceftriaxone sodium is mixed with other drugs for intravenous use. Among them, ceftriaxone sodium mixed with dexamethasone accounted for the majority of intravenous use, followed by mixed intravenous use with ribavirin and other antiviral drugs or Chinese medicine injections. In a few cases, as many as four kinds of drugs were mixed at one time. Typical case] Patient, female, 35 years old, with previous history of penicillin allergy. She was given ceftriaxone sodium 3g with 0.9% sodium chloride 300ml intravenously for mosquito bite secondary infection of lower limbs. About 2 minutes later, the patient complained of shortness of breath, throat itching and general discomfort, the infusion was immediately stopped and relevant drugs were given for resuscitation, and the patient died 15 minutes later. [Expert Analysis] The [Contraindications] and [Precautions] of ceftriaxone sodium instruction clearly state that it is prohibited for patients who are allergic to cephalosporins. “The patient’s allergy history should be asked in detail before using this product. Those who are allergic to penicillin may have cross-allergic reactions to this product and should be used with caution.” National drug allergic to penicillin may produce cross allergic reactions to this product and should be used with caution”. Analysis of the case report database of the National Center for Adverse Drug Reaction Monitoring shows that there are cases of drug use by people with allergies or allergy to ceftriaxone sodium and penicillin, and has led to serious consequences of patient death. Typical case] The patient, male, 60 years old, was given ceftriaxone sodium 3g with 0.9% sodium chloride injection for upper respiratory tract infection and was injected intravenously. On the morning of the third day, the patient suddenly developed dyspnea, weakness, palpitations and other disulfiram-like reactions after drinking alcohol, and was immediately given dexamethasone and other drugs, and the patient’s above symptoms gradually decreased. Expert’s analysis] Ceftriaxone sodium can affect the metabolism of ethanol, causing the concentration of acetaldehyde in blood to rise and disulfiram-like reactions to occur. Therefore, alcohol should be avoided during the drug administration and within 1 week after stopping the drug, and oral administration of ethanol-containing drugs and drinks or intravenous input of ethanol-containing drugs should also be avoided. Typical case] The patient, male, 34 years old, was given ceftriaxone sodium 2g in 250ml of glucose sodium chloride injection intravenously after extracorporeal lithotripsy for kidney stone. After 10 ml of drip, the patient felt palpitations, nausea, vomiting, cyanosis, blood pressure was measured at 80/50mmHg, the infusion was stopped immediately, oxygen was administered, dexamethasone 10 mg was given intravenously. 10 minutes later, the patient developed respiratory distress, irritability and dental closure, and targeted treatment was given immediately, and the above symptoms were relieved. Expert analysis] The perioperative medication should comply with the “Guidelines for the Clinical Application of Antimicrobial Drugs” and “Guidelines for the Preventive Use of Antimicrobial Drugs in the Perioperative Period” and other relevant requirements. According to the case report database of the National Center for Adverse Drug Reaction Monitoring, there are 46 cases of perioperative use of ceftriaxone sodium in the serious case reports, mainly involving improper timing of drug use, high starting point of drug use or drug use without indications, long course of drug use, etc., which can cause serious adverse events. Problem 7: Neonatal hyperbilirubinemia medication [typical case] The child, male, born 9 days, was given ceftriaxone sodium 0.3g in 20ml of saline, 10ml of gardenia yellow in 20ml of 10% glucose injection and 0.25g of vitamin C, 25mg of vitamin B6, 10mg of ATP and 25U of coenzyme A in 10% glucose for neonatal hyperbilirubinemia. 60ml intravenous drip once a day. On the third day, the child developed fever and shortness of breath, and eventually died after resuscitation. Expert analysis] The instruction of ceftriaxone sodium clearly indicates that ceftriaxone sodium can displace bilirubin from serum albumin. Newborns with hyperbilirubinemia (especially premature infants) may develop nuclear jaundice and should be used with caution or avoid using this product. However, information from the case report database of the National Center for Monitoring Adverse Drug Reactions shows that ceftriaxone sodium is still used clinically in neonates with hyperbilirubinemia.