Ceftriaxone

Indications

Ceftriaxone is used for: 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

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

Contra Indications

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.

Precautions

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

Pregnancy-Lactation

Interactions

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.

Adverse Effects

Side effects of Ceftriaxone : >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

Mechanism 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.