ceftriaxone / Generic mfg. - LARVOL DELTA

Beyond the Cumulative Antibiogram: A Weighted-Incidence Syndromic Combination Antibiogram to Guide Empirical Therapy of Bloodstream Infections in the Emergency Department. (PubMed, Infect Dis Ther) - "WISCA complements the cAST by providing regimen-level, syndrome- and subgroup-specific coverage estimates, capturing pathogen diversity missed by species-threshold cAST reporting. Integrating WISCA into local antimicrobial-stewardship programs may refine empirical treatment choices for ED bacteremia, especially according to the BSI source and patient-specific characteristics, while supporting judicious use of broad-spectrum agents."

Journal • Infectious Disease • Nephrology

Individualized PMN:RBC Correction for Hemorrhagic Ascites in a Cirrhotic Patient With Marked Peripheral Neutrophilia (ACG 2026) - "He received 7 days of ceftriaxone for SBE treatment but was not started on long-term SBP prophylaxis...c. Negative corrected PMN values indicate estimated blood-contaminant PMNs exceeded observed PMNs and were interpreted as no residual neutrocytosis."

Clinical • Addiction (Opioid and Alcohol) • Fibrosis • Hematological Disorders • Hepatology • Immunology • Infectious Disease • Liver Cirrhosis • Pneumonia • Pulmonary Disease • Respiratory Diseases

A Rare Case of Concomitant Leptospirosis and Hepatitis B Infection: A Diagnostic Challenge in Identifying Etiology of Acute Liver Injury (ACG 2026) - "Entecavir was started for treatment of chronic HBV, but his liver function and jaundice worsened, with MELD peaking at 36 and total bilirubin at 32.1...The patient was treated with ceftriaxone with marked improvement in liver chemistries and kidney function...The severity of the liver injury, severe thrombocytopenia, and severe acute kidney injury were inconsistent with chronic HBV when considering the presentation with myalgias, chills, and soil/freshwater exposure. Therefore, it is important for clinicians to consider leptospirosis testing in patients from endemic areas or with relevant environmental exposures who present with characteristic clinical features to allow for prompt recognition and treatment."

Clinical • Acute Kidney Injury • Fibrosis • Hematological Disorders • Hepatitis B • Hepatology • Immunology • Infectious Disease • Inflammation • Liver Failure • Musculoskeletal Pain • Nephrology • Renal Disease • Thrombocytopenia

Recurrent Flood Syndrome Complicated by Enterococcus Faecalis Peritonitis: Successful Conservative Management in Decompensated Cirrhosis (ACG 2026) - "Empiric ceftriaxone and metronidazole were started, then narrowed to IV ampicillin after ascitic fluid cultures grew ampicillin-sensitive E. faecalis. This case supports proactive elective surgical evaluation and TIPS reassessment once medically optimized. Figure: Figure 1 A: Spontaneous ascitic fluid drainage from an umbilical hernia (Flood syndrome) B: CT abdomen and pelvis showing a 1.6 cm rim-enhancing fluid collection adjacent to the left aspect of the supraumbilical hernia"

Cardiovascular • Fibrosis • Gastroenterology • Hepatology • Hypotension • Immunology • Infectious Disease • Portal Hypertension

Flood Syndrome Secondary to BuddâChiari Syndrome: A Case Report (ACG 2026) - "Prophylactic ceftriaxone, metronidazole were given and patient was optimized on a spironolactone and torsemide regimen to reduce ascitic fluid pressure. The patient was instructed on regular follow-up and strict compliance to her BCS regimen including rivaroxaban, carvedilol...This case expands the etiological spectrum of Flood syndrome and emphasizes that BCS should be considered as a potential cause in patients presenting with spontaneous umbilical ascitic leakage. Figure: Picture depicting the sinus tract on skin"

Case report • Clinical • Cardiovascular • Fibrosis • Gastroenterology • Hepatology • Immunology • Infectious Disease • Portal Hypertension • Thrombosis

Noncirrhotic Portal Hypertension From Porto-Sinusoidal Vascular Disease Following Immune Checkpoint Inhibitor Therapy (ACG 2026) - "Case Description/ A 38-year-old man with stage III metastatic melanoma was treated with nivolumab/ipilimumab followed by nivolumab (2023â2025), with his final dose in July 2025...Management included ceftriaxone for SBP (transitioned to ciprofloxacin prophylaxis), serial large-volume paracentesis, diuretic titration, and a prednisone taper...D. Elastic stain (10x) shows mild central vein fibrosis."

Checkpoint inhibition • Cardiovascular • Cholestasis • Fibrosis • Hematological Disorders • Hepatology • Immunology • Liver Cirrhosis • Liver Failure • Melanoma • Oncology • Portal Hypertension • Solid Tumor • Thrombosis

Gallstone Hepatitis Unmasked: E. coli Bacteremia Secondary to Choledocholithiasis Presenting With Transaminases Exceeding 3,000 IU/L (ACG 2026) - "Further history revealed upper respiratory symptoms, abdominal discomfort, and low-grade fever, prompting evaluation by her primary care physician and treatment with cephalexin for presumed urinary tract infection...She was initiated on N-acetylcysteine therapy given concern for impending hepatic failure...Blood cultures subsequently grew Escherichia coli and Aeromonas hydrophila/caviae, prompting initiation of ceftriaxone therapy...This case highlights the importance of maintaining biliary obstruction in the differential diagnosis of marked hepatocellular injury. Early recognition and biliary decompression with ERCP are critical, as prompt intervention can result in rapid clinical and biochemical recovery."

Autoimmune Hepatitis • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Hepatology • Immunology • Infectious Disease • Inflammation • Liver Failure • Nephrology • Septic Shock

Gonococcal Proctocolitis Mimicking Ulcerative Colitis (ACG 2026) - "The patient was treated with guideline-directed ceftriaxone therapy and supportive intravenous hydration, resulting in rapid clinical improvement...Careful infectious evaluation, including sexually transmitted infection screening, is essential to avoid misdiagnosis, unnecessary immunosuppression, and delays in appropriate therapy. This case emphasizes the importance of incorporating infectious and sexually transmitted disease screening into the evaluation of new-onset colitis to improve diagnostic accuracy and optimize patient management."

Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Ulcerative Colitis

Endoscopic Hemostasis of Diverticular Bleeding in the Third Portion of the Duodenum: A Rare Clinical Entity With Diagnostic and Therapeutic Challenges (ACG 2026) - "The patient was started on IV PPI, ceftriaxone, and octreotide drip given history of cirrhosis. We also demonstrate the feasibility and effectiveness of endoscopic hemostasis. Figure: Figure: Endoscopic images of an actively bleeding vessel in the diverticulum in the third portion of the duodenum (A-C), treated successfully with epinephrine injection followed by placement of four short hemoclips (D)."

Clinical • Cardiovascular • Diabetes • Fibrosis • Gastroenterology • Gastrointestinal Disorder • Hepatology • Immunology • Metabolic Disorders

Esophageal Blebs as a Clue to Occult Descending Aortic Dissection (ACG 2026) - "He received pantoprazole, octreotide, ceftriaxone, and fluids, then was transferred for EGD...Blood cultures grew MSSA, suspected from leg wounds, and cefazolin was started...Although imaging showed no compression, coexistence of esophageal submucosal discoloration and thoracic aortic intramural pathology suggests an association. Figure: Localized moderate mucosal changes characterized by congestion, erythema, erosion and altered texture were found in the lower third of the esophagus Figure: Esophageal blebbing seen on EGD"

Addiction (Opioid and Alcohol) • Cardiovascular • CNS Disorders • Epilepsy • Fibrosis • Gastrointestinal Disorder • Hematological Disorders • Hepatology • Immunology • Infectious Disease • Inflammation • Nicotine Addiction • Pneumonia • Portal Hypertension • Respiratory Diseases • Thrombosis

A Rare Presentation of Ischemic Colitis During Pregnancy (ACG 2026) - "She received a three-day course of intravenous ceftriaxone and metronidazole, along with polyethylene glycol and psyllium for constipation...This case adds to the limited literature, demonstrat ing the importance of maintaining vigilance for C I even in otherwise healthy young adults, particularly pregnant women, who present with painful hematochezia. Figure: Abrupt erythema, edema, and linear ulcer in the proximal sigmoid extending past visualization consistent with ischemic colitis"

Cardiovascular • Constipation • Gastroenterology • Gastrointestinal Disorder • Immunology • Obstetrics • CRP

Perforated Low-Grade Appendiceal Mucinous Neoplasm Incidentally Discovered During Evaluation of Pneumonia-Associated Encephalopathy (ACG 2026) - "Case Description/ A 75-year-old man with atrial fibrillation on warfarin, chronic kidney disease, diabetes, and recent prosthetic joint septic arthritis on daptomycin/ceftriaxone presented with encephalopathy, cough, dysuria, and hypoxia to 88%. Figure: Figure 1: Intraoperative findings of large volume of thick, gelatinous, mucinous material in the right lower quadrant/pelvis highly concerning for mucinous malignancy. The appendix appeared to be completely obliterated"

Appendix Cancer • Atrial Fibrillation • Cardiovascular • Chronic Kidney Disease • CNS Disorders • Cough • Diabetes • Diabetic Nephropathy • Immunology • Infectious Disease • Metabolic Disorders • Nephrology • Pneumonia • Pulmonary Embolism • Renal Disease • Respiratory Diseases

A Rare Case of Therapeutic Amphetamine-Dextroamphetamine-Induced Ischemic Colitis in a Middle-Aged Woman Without Traditional Vascular Risk Factors (ACG 2026) - "Amphetamine-dextroamphetamine (Adderall), commonly prescribed for ADHD, has rarely been implicated...Medications included amphetamine-dextroamphetamine ER 15 mg daily, semaglutide, escitalopram, clonidine, and rosuvastatin...The medication was discontinued, and the patient improved with IV fluids, ceftriaxone, and metronidazole...As prescription stimulant use increases, clinicians should remain aware of this rare adverse effect, as early recognition and discontinuation of the offending agent may prevent recurrent ischemia and complications. Figure: Ischemic-type changes characterized by hyalinization of the lamina propria (highlighted by the Sirius red stain), surface erosion, withering crypts and focal pseudomembranous exudates Figure: Segmental mucosal friability and ulcerative ischemic injury involving the sigmoid colon"

Clinical • ADHD (Impulsive Aggression) • Attention Deficit Hyperactivity Disorder • Cardiovascular • CNS Disorders • Cognitive Disorders • Endometriosis • Gastroenterology • Gastrointestinal Disorder • Gynecology • Hematological Disorders • Immunology • Inflammation • Women's Health

The Paradox of Pancreatic Ascites: Bacterial Peritonitis Secondary to a Pancreatic Duct Leak in the Absence of Cirrhosis - A Case Report (ACG 2026) - "IV ceftriaxone was initiated...(A) Coronal reformat demonstrating a large pancreatic pseudocyst measuring 6.2 x 6.2 x 5.5 cm with associated massive ascites. (B) Axial image demonstrating pancreatic duct dilation measuring 4.6 mm, consistent with upstream dilatation secondary to a pancreatic duct stricture in the setting of chronic calcific pancreatitis."

Case report • Clinical • Addiction (Opioid and Alcohol) • Cardiovascular • Fibrosis • Hematological Disorders • Hepatology • Immunology • Infectious Disease • Inflammation • Liver Cirrhosis • Pancreatitis • Portal Hypertension

Whipple's Disease With CNS Involvement (ACG 2026) - "Based on these findings and social considerations, the patient was discharged on oral doxycycline and hydroxychloroquine...He was later transitioned to complete intravenous ceftriaxone for a total of 14 days, followed by trimethoprim sulfamethoxazole with planned 12-month therapy...Histiocytes showing granular positivity with this OAS-D stain, consistent with Whipple's disease. D: Endoscopic View of second portion of duodenum 6-months into treatment with improving inflammation."

CNS Disorders • Gastrointestinal Disorder • Hematological Disorders • Immunology • Infectious Disease • Inflammation • Musculoskeletal Pain

A Rare Cause of Hemorrhagic Shock in Cirrhosis: Ectopic Superior Mesenteric Vein Varices (ACG 2026) - "The patient was managed with octreotide infusion, ceftriaxone, and critical care measures...It leaves few effective treatment options. Early recognition is crucial to facilitate timely intervention, which improves outcomes."

Cardiovascular • Fibrosis • Gastroenterology • Hematological Disorders • Hepatology • Immunology • Liver Failure • Metabolic Dysfunction-Associated Steatohepatitis • Portal Hypertension • Thrombocytopenia

Bleeding Through the Belly Button: Umbilical Variceal Hemorrhage as the Initial Presentation of Portal Hypertension (ACG 2026) - "He remained hemodynamically stable and was started on octreotide and ceftriaxone...Lactulose was started following the procedure for hepatic encephalopathy prophylaxis...Figure: Sagittal CT abdomen and pelvis demonstrating paraumbilical varices within an umbilical hernia sac (arrow), consistent with ectopic umbilical varices in the setting of portal hypertension. Figure: Axial CT abdomen and pelvis demonstrating recanalized paraumbilical veins with varices extending into the umbilical hernia sac, consistent with ectopic umbilical varices related to portal hypertension."

Cardiovascular • CNS Disorders • Fibrosis • Gastroenterology • Hematological Disorders • Hepatic Encephalopathy • Hepatology • Immunology • Portal Hypertension

A Case of Leptospirosis Disguised as Alcohol-Related Hepatitis in a Patient With Cirrhosis (ACG 2026) - "Given the long testing time for Leptospira, empiric ceftriaxone was initiated for two weeks...While the clinical picture initially suggested alcohol-related hepatitis, empiric steroid therapy in this context could have worsened the patientâs condition. This case underscores the need to exclude infectious etiologies in patients with liver disease, especially given the liverâs central role in immune regulation."

Clinical • CNS Disorders • Fibrosis • Hepatic Encephalopathy • Hepatology • Immunology • Infectious Disease • Inflammation

The Catâs out of the Bag: Granulomatous Hepatitis Due to Bartonella Henselae (ACG 2026) - "He received ceftriaxone and metronidazole for one week due to concerns for liver abscess...Macrolides, doxycycline, or erythromycin are typical antibiotics used to treat B. henselae...Figure: 3 month follow up CT Abdomen/Pelvis demonstrating a decrease in size of hypodense lesion in hepatic segment 7 (1.1 x 0.9 cm, previously 1.6 x 1.5 cm). and lesion in segment 3 (1.9 x 1.2 cm, previously 2.0 x 1.6 cm), thought to represent granulomatous infection."

Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Hepatitis C • Hepatology • Immunology • Infectious Disease • Inflammation • Respiratory Diseases • Tuberculosis

One Bad Burger: A Rare Recipe for a Hepatic Abscess (ACG 2026) - "Patient was initially started on ceftriaxone, however persistent fevers prompted additional evaluation with Computed tomography (CT) of abdomen/pelvis which revealed a 3.9 cm liver abscess in the right hepatic dome (Fig...Blood cultures grew Fusobacterium species, prompting escalation to piperacillinâtazobactam...Due to the subdiaphragmatic location of the abscess with limited percutaneous access, the patient was referred to a tertiary center for percutaneous drainage followed by two weeks of oral ciprofloxacin...Figure: Figure 1: Computerized Tomography of the abdomen and pelvis demonstrating via the black arrow the liver abscess in the hepatic dome. Figure: Figure 2: Magnetic Resonance Imaging of the liver further demonstrates, via the orange arrow, an approximately sixty-eight millimeter liver abscess."

Cardiovascular • Hematological Disorders • Hepatology • Human Immunodeficiency Virus • Infectious Disease • Inflammation • Metabolic Disorders • Thrombosis

Fever, Elevated Liver Enzymes, and Occupational Exposure: A Case of Acute Q Fever (ACG 2026) - "The patient was then treated empirically with vancomycin, rocephin and metronidazole...He was discharged with doxycycline and outpatient follow up...Patients left untreated can develop chronic infections such as endocarditis requiring long term antibiotics and immunomodulators. Maintaining a high index of suspicion in the appropriate populations can prevent life-altering sequelae of the disease and ensure a favorable outcome."

Clinical • Acute Kidney Injury • Cardiovascular • Diabetes • Dyslipidemia • Gastroenterology • Heart Failure • Hepatology • Hypertension • Infectious Disease • Inflammation • Metabolic Disorders • Nephrology • Pneumonia • Renal Disease • Respiratory Diseases • Septic Shock

Rare Case of Salmonella Bacteremia Mimicking Severe Sepsis With Pulmonary Embolism in a Traveler (ACG 2026) - "Blood cultures later grew Salmonella species sensitive to ceftriaxone and trimethoprim-sulfamethoxazole. The patient required ICU admission and treatment with intravenous heparin followed by apixaban, along with targeted antimicrobial therapy...This confirms the diagnosis of acute pulmonary embolism Figure: CT scan of the chest in lung window demonstrates wedge-shaped infarction. These findings are compatible with segmental pulmonary emboli"

Clinical • Cardiovascular • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Infectious Disease • Inflammation • Malaria • Pulmonary Embolism • Respiratory Diseases • Septic Shock • Thrombocytopenia • Venous Thromboembolism

Pyoderma Gangrenosum and Inflammatory Arthropathy as the Initial Presentation of Inflammatory Bowel Disease Mimicking Sepsis (ACG 2026) - "Wound cultures grew coagulase-negative Staphylococcus, and he was treated with intravenous ceftriaxone followed by oral doxycycline with minimal improvement...The patient was transitioned to infliximab with sustained clinical response...In this case, poor response to antibiotics prompted further evaluation, leading to the diagnosis of underlying IBD with extraintestinal manifestations. Clinicians should consider inflammatory etiologies when ulcerative skin lesions fail to improve with antimicrobial therapy, particularly in the presence of gastrointestinal symptoms, to avoid delayed immunosuppressive treatment."

Addiction (Opioid and Alcohol) • Colorectal Cancer • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Hypotension • Immunology • Infectious Disease • Inflammation • Inflammatory Arthritis • Inflammatory Bowel Disease • Musculoskeletal Pain • Pyoderma Gangrenosum • Rheumatology • Septic Shock • Vasculitis

Isolated Gastric Varices Without Portal Hypertension in a Young Woman With NSAID Overuse and Recurrent Hematemesis (ACG 2026) - "Case Description/ We present a 42-year-old woman with type 1 diabetes and hypertension, transferred after sudden-onset hematemesis and syncope (hemoglobin 6.9 g/dL), with recent ibuprofen use up to 3,600 mg/day...Blood cultures grew pan-sensitive E. coli; imaging revealed left-sided pyelonephritis, the likely driver of NSAID overuse, treated with IV ceftriaxone...Endoscopic guided image of an isolated gastric fundus varix (IGV1) Figure: Figure 1b. Close-up of IGVI prior to rupture"

Clinical • Cardiovascular • Diabetes • Fibrosis • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Hepatology • Hypertension • Immunology • Inflammation • Liver Cirrhosis • Metabolic Disorders • Nephrology • Peptic Ulcer • Portal Hypertension • Thrombosis • Type 1 Diabetes Mellitus • Varicose Veins

Encapsulating Peritoneal Sclerosis Presenting in a Non-Peritoneal Dialysis Patient (ACG 2026) - "Admitted to the ICU and treated with octreotide, transfusions, pantoprazole, ceftriaxone, and albumin. Early recognition is critical, as management may require a multidisciplinary approach for optimal patient outcomes. Figure: Image 1: A huge abdominopelvic lobulated high density fluid capsulated collection measuring 30 x 28 x 8 cm at its maximum craniocaudal, transverse, and anterior-posterior diameters Figure: Table 1: Comparison of serial paracentesis findings demonstrating progressive inflammation"

Clinical • Acute Kidney Injury • CNS Disorders • Fibrosis • Hematological Disorders • Hepatic Encephalopathy • Hepatitis C • Hepatology • Immunology • Infectious Disease • Inflammation • Liver Cirrhosis • Metabolic Disorders • Nephrology • Renal Disease