Generic Name

Ceftriaxone

Precaution

History of penicillin allergy; severe renal impairment; pregnancy and lactation; superinfection. Lactation: Drug enters breast milk in low concentrations; use with caution

Indication

Pneumonia, Meningitis, Acute otitis media, Lyme disease, Typhoid fever, Otitis media, Pelvic inflammatory disease, Septicemia, Skin and Skin-Structure Infections, Gonorrhea, Respiratory tract infections, Urinary tract infections, Bone and Joint Infections, Chlamydia infection, Surgical Prophylaxis

Contra Indication

Hypersensitivity to cephalosporins; hyperbilirubinaemic neonates. Do not use calcium or calcium-containing solutions or products with or within 48 hr of ceftriaxone administration due to risk of calcium-ceftriaxone precipitate formation.

Dose

N/A

Side Effect

>10% Induration after IM injection (5-17%) 1-10% Eosinophilia (6%),Thrombocytosis (5%),Diarrhea (3%),Elevated hepatic transaminases (3%),Leukopenia (2%),Rash (2%),Increased blood urea nitrogen (BUN) (1%),Induration at IV site (1%),Pain (1%) <1% Agranulocytosis,Anaphylaxis,Anemia,Basophilia,Bronchospasm,Candidiasis,Chills,Diaphoresis,Dizziness,Dysgeusia,Flushing,Gallstones,Glycosuria,Headache,Hematuria,Hemolytic anemia,Increased alkaline phosphatase or bilirubin,Increased creatinine,Jaundice,Leukocytosis,Lymphocytosis,Lymphopenia,Monocytosis,Nausea,Neutropenia,Phlebitis,Prolonged or decreased prothrombin time (PT),Pruritus,Renal stones,Serum sickness,Thrombocytopenia,Urinary casts,Vaginitis,Vomiting

Pregnancy Category

Mode of Action

Ceftriaxone binds to one or more of the penicillin-binding proteins (PBPs) which inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell death.

Interaction

May increase nephrotoxicity of aminoglycosides. May diminish therapeutic effect of BCG, typhoid vaccine, Na picosulfate. May increase anticoagulant effect of vit K antagonists (e.g. warfarin). May increase serum level w/ probenecid. Potentially Fatal: Admin w/ Ca-containing IV soln may cause precipitation of a crystalline material in the lungs and kidneys.

Pregnancy Category Note

Pregnancy category: B Lactation: Drug enters breast milk in low concentrations; use with caution

Adult Dose

Susceptible infections IV/IM 1-2 g/day, up to 4 g/day for severe infections. Intra-abdominal Infections Complicated, mild-to-moderate, community acquired: 1-2 g/day IV in single daily dose or divided q12hr for 4-7 days, in combination with metronidazole Meningitis 2 g IV q12hr for 7-14 days Acute Uncomplicated Pyelonephritis 1-2 g IV qDay Typhoid fever 2 g IV once daily for 14 days. Surgical Prophylaxis Prophylaxis of surgical infection 1 g IV 0.5-2 hours before procedure Uncomplicated Gonococcal Infections Uncomplicated gonococcal infection of pharynx, cervix, urethra, or rectum: ceftriaxone 250 mg IM once plus azithromycin 1 g PO once (preferred) or alternatively, doxycycline 100 mg PO q12hr for 7 days Pelvic Inflammatory Disease 250 mg IM as single dose with doxycycline, with or without metonidazole for 14 days

Child Dose

Children: IV, IM: 50–75 mg/kg/day, max 2 g/day q24h 50 mg/kg, max 1 g, 1–3 doses IM for AOM q24h 100 mg/kg/day for meningitis, max 4 g/day q12h

Renal Dose

Renal impairment: CrCl (ml/min) <10 Max: 2 g daily.

Administration

IV/IM Administration IV: Infuse intermittently over 30 minutes IM: Inject deep into large muscle mass