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Ceftriaxone

    Brands

    DEA Class; Rx

    Common Brand Names; Rocephin (DSC)

    • Cephalosporins, 3rd Generation

    Parenteral third-generation cephalosporin antibiotic
    Used to treat infections such as gonorrhea, respiratory tract infections, and meningitis
    Has longest half-life of all cephalosporins, allowing for once-daily dosing and for outpatient therapy

    Indicated for the treatment of bacteremia and sepsis.

    For the treatment of urinary tract infection (UTI).
    For the treatment of acute otitis media.
    For the treatment of skin and skin structure infections, including cellulitis, erysipelas, necrotizing infections, animal bite wounds, leg ulcer, diabetic foot ulcer, and surgical incision site infections.
    For surgical infection prophylaxis.
    For the treatment of bone and joint infections (i.e., osteomyelitis, prosthetic joint infections).
    For the treatment of lower respiratory tract infections (LRTIs), including community-acquired pneumonia (CAP) and pleural empyema.
    For the treatment of infective endocarditis.
    For the treatment of meningitis and ventriculitis.
    For the treatment of gonorrhea, including bacterial conjunctivitis and ophthalmia neonatorum.
    For the treatment of epididymitis.
    For gonorrhea prophylaxis, including ophthalmia neonatorum prophylaxis.
    For the treatment of intraabdominal infections, including peritonitis, appendicitis, intraabdominal abscess, biliary tract infections (cholecystitis), spontaneous bacterial peritonitis, and peritoneal dialysis-related peritonitis.

    Documented hypersensitivity; hyperbilirubinemic neonates, particularly those who are premature; neonates <28 days if they receive calcium-containing IV products

    Intravenous administration of ceftriaxone solutions containing lidocaine

    Lidocaine contraindications if lidocaine solution used as solvent with ceftriaxone for intramuscular injection

    • Induration after IM injection (5-17%)
    • 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%)
    • 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

    10-g pharmacy bulk package should not be used for direct infusion

    Immune-mediated hemolytic anemia reported; if patient develops anemia while on ceftriaxone, stop antibiotic until etiology determined; severe hemolytic anemia, including fatalities, reported in both adults and children

    May increase INR, especially in nutritionally deficient patients, hepatic or renal disease or prolonged treatment

    Dosage must be adjusted in severe renal insufficiency (high dosages may cause CNS toxicity)

    Superinfections and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy

    Use with caution in patients with history of penicillin allergy

    Use with caution in patients with history of GI disease, especially colitis

    Use with caution in breast-feeding women; drug may displace bilirubin from albumin-binding sites, increasing risk of kernicterus

    Abnormal gallbladder sonograms reported, possibly the result of ceftriaxone-calcium precipitates; discontinue if signs or symptoms of gallbladder disease occur

    Ceftriaxone-calcium precipitates in urinary tract observed in patients receiving ceftriaxone; may be detected as sonographic abnormalities; patients may be asymptomatic or may develop symptoms of urolithiasis, and ureteral obstruction and post-renal acute renal failure; appears to be reversible upon discontinuation of therapy and institution of appropriate management; ensure adequate hydration; discontinue therapy in patients who develop signs and symptoms suggestive of urolithiasis, oliguria or renal failure and/or the sonographic findings

    Available data from published prospective cohort studies, case series, and case reports over several decades in pregnant women have not established a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes

    Data from published literature report that ceftriaxone is present in human milk; there are no data on effects of drug on breastfed child or on milk production

    Adults

    7.5 g/day IV (6 g/day ceftazidime and 1.5 g/day avibactam).

    Geriatric

    7.5 g/day IV (6 g/day ceftazidime and 1.5 g/day avibactam).

    Adolescents

    187.5 mg/kg/day IV (150 mg/kg/day ceftazidime and 37.5 mg/kg/day avibactam; Max: 7.5 g/day [6 g/day ceftazidime and 1.5 g/day avibactam]).

    Children

    187.5 mg/kg/day IV (150 mg/kg/day ceftazidime and 37.5 mg/kg/day avibactam; Max: 7.5 g/day [6 g/day ceftazidime and 1.5 g/day avibactam]).

    Infants

    6 to 11 months: 187.5 mg/kg/day IV (150 mg/kg/day ceftazidime and 37.5 mg/kg/day avibactam).
    3 to 5 months: 150 mg/kg/day IV (120 mg/kg/day ceftazidime and 30 mg/kg/day avibactam).
    1 to 2 months: Safety and efficacy have not been established.

    Neonates

    Safety and efficacy have not been established.

    Ceftriaxone

    injectable solution

    • 1g/50mL
    • 2g/50mL

    powder for injection

    • 250mg
    • 500mg
    • 1g
    • 2g
    • 10g
    • 100g