Ceftriaxone + Sulbactam
Indications
Ceftriaxone + Sulbactam is used for:
Treatment of lower resp tract infections; acute bacterial otitis media; skin & skin structure infections; UTI (complicated & uncomplicated); pelvic inflammatory disease; bone & joint infections; intra-abdominal infections; meningitis; resistant typhoid; STD; surgical prophylaxis; bacterial septicemia.
Adult Dose
Adult 1-2 g once daily (or in 2 divided doses). Max: 4 g/day.
Uncomplicated gonococcal infections 250 mg IM as a single dose.
Surgical prophylaxis 1 g IV single dose, ½-2 hr before surgery.
Meningitis Initially 100 mg/kg/day. Max: 4 g/day. Duration: 7-14 days.
Strep pyogenes infections Continue therapy for at least 10 days.
Child Dose
Childn
Skin & skin structure infections
Ceftriaxone 50-75 mg/kg once daily (or in equally divided doses). Max: 2 g/day.
Acute bacterial otitis media 50 mg/kg as single IM dose. Max: 1 g.
Meningitis Initially 100 mg/kg/day. Max: 4 g/day. Duration: 7-14 days.
Treatment of serious miscellaneous infection other than meningitis 50-75 mg/kg/day. Max: 2 g/day.
Renal Dose
Administration
Contra Indications
Hypersensitivity to cephalosporins. History of hypersensitivity to penicillins.
Precautions
Avoid in patients w/ history of anaphylactic hypersensitivity reaction to penicillins. Monitor during therapy for potential super- or suprainfection. Pregnancy & lactation.
Pregnancy-Lactation
Interactions
May increase effects of anticoagulants. Potential disulfiram-like reaction w/ alcohol.
Adverse Effects
Side effects of Ceftriaxone + Sulbactam :
GI effects including dose-related nausea, vomiting, diarrhea, abdominal cramps & flatulence. Dry mouth, bad taste, glossitis, furry tongue, anorexia, rectal bleeding & vaginitis.
Mechanism of Action
Ceftriaxone is a 3rd-generation cephalosporin antibiotic with a broad-spectrum activity which includes gram-positive and gram-negative aerobic and anaerobic bacteria.
Ceftriaxone has a high degree of stability in the presence of beta-lactamase, both penicillinases and cephalosporinase of gram-positive and gram-negative bacteria. The bactericidal activity of ceftriaxone sodium results from inhibition of cell wall synthesis.
Sulbactam is a potent, highly specific inhibitor of a wide variety of beta-lactamase produced by common gram-negative and gram-positive aerobes and anaerobes. By forming a protein complex with beta-lactamase, sulbactam irreversibly blocks their destructive hydrolytic activity. Thus, the full potential of ceftriaxone against Enterobacter and Pseudomonas species is restored by the addition of sulbactam.
The combination of sulbactam and ceftriaxone sodium is active against all the organisms sensitive to ceftriaxone. In addition, it demonstrates synergistic activity [reduction in minimum inhibitory concentrations (MICs) for the combination versus those of each component] in a variety of organisms.