Ceftriaxone

Ceftriaxone

[1 vial $5.55]

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:
    500mg, 1g and 2g 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:

Inject slowly over 3-5 minutes
Store at room temperature
Compatible with:
Normal saline, Glucose and sodium chloride, glucose 5%

  • IM:
    Reconstitute with 0.5% lignocaine as follows:

DOSAGE:

  • IV:
    1-2g daily; for bacterial meningitis 4g daily is required and is often administered as 2g 12 hrly

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose as in normal renal function

DOSAGE IN PAEDIATRICS:

  • IV:
    50mg/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 (max. 2000 mg/dose) every 24 hours 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, e.g., 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 FOR THE ICU

  • None of note.

ADVERSE REACTIONS

  • Body as a Whole:
    serum sickness, diaphoresis and flushing
  • Haematological System:
    Agranulocytosis, leukocytosis, leukopenia, lymphocytosis, thrombocytopenia, 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 ceftriaxone, the following adverse 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 pancytopenia. Several cephalosporins have been implicated in triggering seizures, paticularly 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

Critical Care Drug Manual

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