A nurse is preparing to administer the initial dose of ceftriaxone to a client who has endometriosis
Dosing & UsesAdultPediatric Show
Dosage Forms & Strengthsinjectable solution
powder for injection
Intra-abdominal InfectionsComplicated, 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 Acute Bacterial Otitis Media50 mg/kg IM once Persistent or treatment failures: 50 mg/kg IV/IM for 3 days Pelvic Inflammatory Disease250 mg IM as single dose with doxycycline, with or without metronidazole for 14 days Prosthetic Joint Infection2 g IV q24hr for 2-6 weeks; continue treatment until clinical improvement observed and patient is afebrile for 48-72 hr Meningitis2 g IV q12hr for 7-14 days Acute Uncomplicated Pyelonephritis1-2 g IV qDay Surgical ProphylaxisProphylaxis of surgical infection 1 g IV 0.5-2 hours before procedure Uncomplicated Gonococcal InfectionsIndicated for uncomplicated gonococcal infection of pharynx, cervix, urethra, or rectum Weight <150 kg: Ceftriaxone 500 mg IM once Weight ≥150 kg: Ceftriaxone 1,000 mg IM once If chlamydial infection has not been excluded, add doxycycline 100 mg BID x 7 days, or if pregnant give azithromycin 1,000 mg Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020 Sexual assault
Septic/toxic Shock (Off-label)2 g IV once daily; with clindamycin for toxic shock Acute Epididymitis (Off-label)Sexually transmitted chlamydia and gonorrhea
Sexually transmitted chlamydia, gonorrhea, and enteric organisms
Enteric organisms
Skin and Soft Necrotizing Infection (Off-label)Due to Aeromonas hydrophilia: 1-2 g IV qDay in combination with doxycycline Due to Vibrio vulnificus; 1 g IV qDay in combination with doxycycline Continue treatment until further debridement not necessary, clinical improvement observed, and patient is afebrile for 48-72 hr Severe Acute Bacterial Rhinosinusitis (Off-label)Infection requiring hospitalization: 1-2 g IV q12-24hr for 5-7 days Other Gonococcal Infections (Off-label)Gonococcal conjunctivitis: 1 g IM once Disseminated gonococcal infection: 1 g/day IV/IM; continued for at least 24-48 hours after improvement is observed, then continued with cefixime 400 mg PO q12hr to complete at least 1 week of therapy Gonococcal endocarditis: 1-2 g IV q12hr for 4 weeks Gonococcal meningitis: 1-2 g IV q12hr for 10-14 days Acute epididymitis: 250 mg IM once with doxycycline Dosing ConsiderationsSusceptible organisms
Dosage Forms & Strengthsinjectable solution
powder for injection
Acute Bacterial Otitis Media50 mg/kg IM in single dose; not to exceed 1 g Epiglottis (Off-label)100 mg/kg/day IV on first day; follow with 50 mg/kg on day 2 or 75 mg/kg qDay for 10-14 days Meningitis100 mg/kg/day IV/IM in single daily dose or divided q12hr for 7-14 days; not to exceed 4 g/day Serious Infections Other Than Meningitis50-75 mg/kg/day IV/IM divided q12hr for 7-14 days Skin/Skin Structure Infections>12 years: 1-2 g/day IV/IM in single daily dose or divided q12hr for 7-14 days, depending on type and severity of infection Gonococcal InfectionsNeonates
Children
InteractionsInteraction CheckerEnter a drug name and ceftriaxone No Interactions Found Interactions Found ContraindicatedSerious - Use AlternativeSignificant - Monitor CloselyMinorAll Interactions Sort By: Contraindicated (5)
Serious - Use Alternative (9)
Monitor Closely (15)
Minor (4)
Adverse Effects>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 Postmarketing reportsPancreatitis, stomatitis and glossitis Oliguria, ureteric obstruction, post-renal acute renal failure Exanthema, allergic dermatitis, urticaria, edema; acute generalized exanthematous pustulosis (AGEP) and isolated cases of severe cutaneous adverse reactions (erythema multiforme, Stevens-Johnson syndrome or Lyell’s syndrome/toxic epidermal necrolysis) Neurological adverse reactions, including encephalopathy, seizures, myoclonus, and non-convulsive status epilepticus WarningsContraindicationsDocumented 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 Concomitant calcium-ceftriaxone administration
Cautions10-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 Clostridium difficile-associated diarrhea (CDAD reported with use of nearly all antibacterial agents, including ceftriaxone; If CDAD suspected or confirmed, may consider discontinuing ongoing antibacterial use not directed against C. difficile; institute appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C. difficile, and surgical evaluation Pancreatitis secondary to biliary obstruction reported rarely; use with caution in patients with gallbladder, biliary tract, liver, or pancreatic disease and patients with history of penicillin hypersensitivity Inform patients that use of local anesthetics may cause methemoglobinemia, which must be treated promptly; advise patients or caregivers to stop use and seek immediate medical attention if they or someone in their care experience the following signs or symptoms: pale, gray, or blue colored skin (cyanosis); headache; rapid heart rate; shortness of breath; lightheadedness; or fatigue Use with caution in patients with history of GI disease (eg, colitis) Neurological adverse reactions
Pregnancy & LactationPregnancyAvailable 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 The estimated background risk of major birth defects and miscarriage for the indicated population is unknown; all pregnancies have a background risk of birth defect, loss, or other adverse outcomes Animal data
LactationData 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 The developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for drug and dextrose injection and any potential adverse effects on breastfed child from antibiotic for Injection and dextrose injection or from mother’s underlying condition Pregnancy CategoriesA: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. PharmacologyMechanism of ActionThird-generation cephalosporin with broad-spectrum gram-negative activity; has lower efficacy against gram-positive organisms but higher efficacy against resistant organisms; highly stable in presence of beta-lactamases (penicillinase and cephalosporinase) of gram-negative and gram-positive bacteria; bactericidal activity results from inhibiting cell-wall synthesis by binding to 1 or more penicillin-binding proteins; exerts antimicrobial effect by interfering with synthesis of peptidoglycan (major structural component of bacterial cell wall); bacteria eventually lyse because activity of cell-wall autolytic enzymes continues while cell-wall assembly is arrested AbsorptionIM preparation well absorbed Peak plasma time: 2-3 hr (IM) DistributionDistributed throughout body, including gallbladder, lungs, bone, bile, and CSF (higher concentrations achieved when meninges are inflamed); crosses placenta; enters amniotic fluid and breast milk Protein bound: 85-95% Vd: 6-14 L MetabolismMetabolized in liver EliminationHalf-life: 5-9 hr (normal hepatic and renal function); 12-16 hr (mild-to-severe renal impairment) Excretion: Urine (33-67% as unchanged drug), feces AdministrationIV IncompatibilitiesSolution: LR (at drug concentrations >10 mg/mL; compatible at 1 mg/mL) Additive: Aminophylline, clindamycin, linezolid, theophylline, metronidazole (at metronidazole 15 g/L with ceftriaxone 20 g/L; compatible at metronidazole 7.5 g/L with ceftriaxone 10 g/L) Syringe: Lidocaine (variable) Y-site: Alatrofloxacin, amphotericin B cholesteryl sulfate, amsacrine, filgrastim, fluconazole, labetalol, pentamidine, vinorelbine, vancomycin General: Calcium-containing drugs IV/IM PreparationDilutions are stable for 24 hours at room temperature IV
IM
IV/IM AdministrationIV: Infuse intermittently over 30 minutes IM: Inject deep into large muscle mass Images
Copyright © 2010 First DataBank, Inc. Patient HandoutCEFTRIAXONE - INJECTION (SEF-trye-AX-one) COMMON BRAND NAME(S): Rocephin USES: Ceftriaxone is used to treat a wide variety of bacterial infections. This medication belongs to a class of drugs known as cephalosporin antibiotics. It works by stopping the growth of bacteria.This drug is not recommended for use in newborns with high blood bilirubin levels and premature infants due to increased risk of side effects. Ask the doctor or pharmacist for details. HOW TO USE: This medication is given by injection into a muscle or vein as directed by your doctor, usually once or twice daily. The dosage is based on your medical condition and response to treatment. Drink plenty of fluids while using this medication unless your doctor directs you otherwise.If you are using this medication at home, learn all preparation and usage instructions from your health care professional. Avoid mixing ceftriaxone with IV fluids that have calcium in them (such as Ringer's solution, Hartmann's solution, parenteral nutrition-TPN/PPN). Consult your pharmacist for details about the safe use of IV calcium products in infants, children, and adults (see Precautions section). Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.If you are using the frozen pre-mixed solution, thaw the bag at room temperature or in the refrigerator. If the bag is thawed in the refrigerator, let it sit at room temperature at least 1 hour before using. Do not thaw by putting in a water bath or microwaving. After thawing, shake well and squeeze the bag to check for leaks. Discard solution if the bag leaks. Do not re-freeze the solution after thawing.For the best effect, use this antibiotic at evenly spaced times. To help you remember, use this medication at the same time(s) every day.Continue to use this medication for the full time prescribed, even if symptoms disappear after a few days. Stopping the medication too early may result in a return of the infection.Tell your doctor if your condition lasts or gets worse. SIDE EFFECTS: Swelling, redness, or pain at the injection site may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: easy bruising/bleeding, unusual tiredness, symptoms of gallbladder disease (such as stomach/abdominal pain, nausea, vomiting), signs of kidney problems (such as change in the amount of urine), pink/bloody/dark urine, painful/frequent urination, back/side pain, yellowing eyes/skin, uncontrollable movements, confusion, seizures.This medication may rarely cause a severe intestinal condition due to a bacteria called C. difficile. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor right away if you develop: diarrhea that doesn't stop, abdominal or stomach pain/cramping, blood/mucus in your stool.If you have these symptoms, do not use anti-diarrhea or opioid products because they may make symptoms worse.Use of this medication for prolonged or repeated periods may result in oral thrush or a new yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.If ceftriaxone is mixed with a numbing medication (such as lidocaine) before injection into a muscle, it may rarely cause a serious blood problem (methemoglobinemia). Get medical help right away if you have any very serious side effects, including: pale/gray/blue skin, fast heartbeat, shortness of breath.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345. PRECAUTIONS: Before using ceftriaxone, tell your doctor or pharmacist if you are allergic to it; or to other antibiotics (such as penicillins, other cephalosporins); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: gallbladder disease, kidney disease, liver disease, stomach/intestinal diseases (such as colitis).Do not give any products by vein that contain calcium (including IV solutions such as Ringer's solution, Hartmann's solution, parenteral nutrition-TPN/PPN) to a newborn less than 1 month old who is receiving this medication. Doing so can cause serious problems in the vital organs.Ceftriaxone may cause live bacterial vaccines (such as typhoid vaccine) to not work well. Tell your health care professional that you are using ceftriaxone before having any immunizations/vaccinations.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Tell your doctor if you are pregnant before using this medication.This medication passes into breast milk in small amounts and is unlikely to harm a nursing infant. Consult your doctor before breast-feeding. DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: calcium-containing IV fluids.This medication may interfere with certain lab tests (such as certain urine glucose tests), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug. OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: seizures. NOTES: Do not share this medication with others.Lab and/or medical tests (such as complete blood count, kidney function tests) should be done while you are using this medication. Keep all medical and lab appointments. MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up. STORAGE: Consult the product instructions and your pharmacist for storage details. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company. Information last revised January 2022. Copyright(c) 2022 First Databank, Inc. IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs. FormularyFormularyPatient Discounts Adding plans allows you to compare formulary status to other drugs in the same class. To view formulary information first create a list of plans. Your list will be saved and can be edited at any time. Adding plans allows you to:
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