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Vial $0.72

Ceftriaxone

Editor: Updated Class:

ADMINISTRATION ROUTES:

IV or IM

ALTERNATIVE NAMES:

Rocephin

ICU INDICATIONS:

  1. Treatment of infections caused by susceptible organisms
  2. Empirical treatment of bacterial meningitis

PRESENTATION AND ADMINISTRATION:

IV:

500 mg, 1 gm and 2 gm vials of powder

Add appropriate volume of water for injection to a vial then shake well until all powder is dissolved. Prepare the solutions as follows:

Vial size 250 mg 500 mg 1 gm
Volume of diluent 2.3 mL 4.6 mL 9.25 mL
Approximate concentration 100 mg/mL 100 mg/mL 100 mg/mL

Inject slowly over 3-5 minutes. Store at room temperature

Compatible with:

Normal saline, glucose and sodium chloride, 5% dextrose

IM:

Reconstitute with 0.5% lignocaine as follows:

Vial size 250 mg 500 mg 1 gm
Volume of diluent 0.8 mL 1.6 mL 3.25 mL
Approximate concentration 250 mg/mL 250 mg/mL 250 mg/mL

DOSAGE:

IV:

1-2 gm BD

Bacterial meningitis: 4 gm daily given as 2 gm BD

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

Dose as in normal renal function

DOSAGE IN PAEDIATRICS:

IV:

50 mg/kg daily

IM:

Note: for treatment of bacterial meningitis where IV access is not obtained use an IM load of 80-100 mg/kg, then 80-100 mg/kg/dose IM once daily (maximum 2 gm/dose) starting 12 hrs after load

CLINICAL PHARMACOLOGY:

Ceftriaxone is excreted via both biliary and renal excretion. The bactericidal activity of ceftriaxone results from inhibition of cell wall synthesis. Ceftriaxone has a high degree of stability in the presence of beta lactamases, both penicillinases and cephalosporinases, of gram-negative and gram-positive bacteria.

Ceftriaxone has been shown to be active against most strains of the following microorganisms, both in vitro and in clinical infections:

Aerobic Gram-Negative Microorganisms:

  • Acinetobacter calcoaceticus
  • Enterobacter aerogenes
  • Enterobacter cloacae
  • Escherichia coli
  • Haemophilus influenzae (including ampicillin-resistant and beta-lactamase producing strains)
  • Haemophilus parainfluenzae
  • Klebsiella oxytoca
  • Klebsiella pneumoniae
  • Moraxella catarrhalis (including beta-lactamase producing strains)
  • Morganella morganii
  • Neisseria gonorrhoeae (including penicillinase- and nonpenicillinase-producing strains)
  • Neisseria meningitidis
  • Proteus mirabilis
  • Proteus vulgaris
  • Serratia marcescens

Note: many strains of the above organisms that are multiply resistant to other antibiotics ()penicillins, cephalosporins, and aminoglycosides) are susceptible to ceftriaxone

Aerobic Gram-Positive Microorganisms:

  • Staphylococcus aureus (including penicillinase-producing strains)
  • Staphylococcus epidermidis
  • Streptococcus pneumoniae
  • Streptococcus pyogenes
  • Viridans group streptococci

Note: Methicillin-resistant staphylococci are resistant to cephalosporins, including ceftriaxone. Most strains of Group D streptococci and enterococci (e.g. Enterococcus (Streptococcus) faecalis) are resistant

Anaerobic Microorganisms:

  • Bacteroides fragilis
  • Clostridium species
  • Peptostreptococcus species

Note: most strains of Clostridium difficile are resistant

CONTRAINDICATIONS:

  1. Hypersensivity to cephalosporins

WARNINGS:

Anaphylaxis

Cephalosporins are a common cause of anaphylactic reactions and cross reactivity with penicillins may occur.

Pseudomembranous colitis

Pseudomembranous colitis has been reported with nearly all antibacterial agents, including cefotaxime, and may range in severity from mild to life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhoea subsequent to the administration of antibacterial agents.

PRECAUTIONS:

General:

Prescribing Ceftriaxone in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.

Positive direct Coombs' tests have been reported during treatment with the cephalosporin antibiotics. It should be recognised that a positive Coombs' test may be due to the drug.

Laboratory Tests:

No tests additional to usual ICU tests are required

Drug/Laboratory Test Interactions: None of note

IMPORTANT DRUG INTERACTIONS IN ICU:

None of note

ADVERSE REACTIONS:

Body as a Whole:

serum sickness, diaphoresis and flushing

Haematological System:

Agranulocytosis, leukocytosis, leukopaenia, lymphocytosis, thrombocytopaenia, monocytosis, eosinophilia

*Urogenital System:**

Elevated creatinine

Digestive System:

Diarrhoea, abdominal pain, nausea or vomiting, increased ALP and bilirubin

Nervous System:

Headache, dizziness

Skin:

Rash

Cephalosporin-Class Adverse Reactions:

In addition to the adverse reactions listed above that have been observed in patients treated with cefaclor, the following reactions and altered laboratory tests have been reported for cephalosporin-class antibiotics: fever, abdominal pain, superinfection, renal dysfunction, toxic nephropathy, haemorrhage, false positive test for urinary glucose, elevated bilirubin, elevated LDH, and pancytopaenia.

Several cephalosporins have been implicated in triggering seizures, particularly in patients with renal impairment when the dosage was not reduced. If seizures associated with drug therapy occur, the drug should be discontinued. Anticonvulsant therapy can be given if clinically indicated