Pharm

Ceftriaxone

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Ceftriaxone, Rocephin

  • See Also
  1. Third Generation Broad-Spectrum Cephalosporin
  2. Cephalosporin
  3. Cefixime
  4. Cefpodoxime
  5. Cefdinir
  6. Cefotaxime
  • Indications
  1. Pneumonia
  2. Pyelonephritis
  3. Pelvic Inflammatory Disease
  4. Sepsis
  5. Meningitis
  6. Skin and Soft Tissue Infections
  7. Bone and Joint Infections
  8. Intraabdominal infections
  9. Gonorrhea
  10. Lyme Disease
  11. Chancroid
  12. Typhoid Fever
  • Contraindications
  1. Newborns
    1. Kernicterus risk in age <7-14 days
    2. Some studies have shown safety in term infants with inconjugated Hyperbilirubinemia
      1. Amin (2023) J Pediatr 254:91-5 +PMID: 36336007 [PubMed]
  • Mechanism
  1. See Third Generation Broad-Spectrum Cephalosporin
  2. Ceftriaxone has less Staphylococcus and Anaerobic activity than Cefotaxime
    1. Frequently used with Metronidazole (e.g. Intraabdominal infections, Pelvic Inflammatory Disease)
  • Dosing
  1. Background
    1. Dilute in Lidocaine 1% for Intramuscular Injection (risk of Methemoglobinemia)
  2. Child
    1. Standard
      1. Give 50-75 mg/kg/day (max 2 g/day) IV or IM divided every 12-24 hours
    2. Meningitis
      1. Give 100 mg/kg/day (max 4 g/day) IV divided every 12-24 hours (twice daily is preferred)
    3. Otitis Media
      1. Give 50 mg/kg IM single dose (max 1 g)
  3. Adult
    1. See Gonorrhea (and other specific indications listed above)
    2. Standard
      1. Give 1 to 2 grams IM or IV every 24 hours
      2. In adults, 2 gram dose is preferred in >100 kg or critically ill patients
    3. Maximum
      1. Typical Maximum: 4 g/day divided every 12 hours
      2. Lower Maximum: 2 g/day
        1. Elderly
        2. Hepatic dysfunction
        3. Renal Dysfunction
  • Adverse Effects
  1. Biliary disease exacerbation (e.g. Biliary Colic)
    1. Ceftriaxone is excreted in bile and displaces Bilirubin from albumin binding
    2. Risk of acalculous cholestasis
  • Safety
  1. Pregnancy Category B
  2. Safe in Lactation
  • Drug Interactions
  1. Prothrombin Time or INR
    1. Increased prothombin time
  2. Intravenous Calcium or Calcium Containing Solutions (e.g. LR, Hartmann's Solution, TPN)
    1. Risk of Ceftriaxone and Calcium preciptation
    2. Precipitation is also associated with lethal lung and Renal Injury in newborns
  • Resources
  1. Ceftriaxone
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5cd2d96f-83e5-4326-ae87-d0ede4ba493a
  • References
  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  2. (2012) Presc Lett, Resource #280706, Comparison of Cephalosporins