ceftriaxone

see also:

• cephalosporins

• a 3rd generation broad spectrum parenteral cephalosporin
• similar antibiotic coverage to cefotaxime but can be given in once daily or twice daily dosing.
• im doses are usually given with local anaesthetic added
• category B1 for pregnancy
• low concentrations of ceftriaxone are excreted in human milk
• dosage adjustments should not be necessary in patients with hepatic dysfunction
• half-life of ceftriaxone may be prolonged in some patients with renal failure, adjustment of dosage may be required.

• should not be used if PH severe type 1 HS reaction to penicillin or any HS to cephalosporin
• im solution should not be used in those hypersensitive to local anaethetics such as lignocaine
• must not be administered with calcium containing solutions in newborn infants because of the risk of precipitation of ceftriaxone calcium salt.
• ceftriaxone and IV calcium containing solutions must not be administered within 48 hours of each other in newborn infants

• hypersensitivity reactions - as with other cephalosporins there is some cross-reactivity with penicillin allergy
• biliary sludging - may rarely cause pancreatitis
• antibiotic-associated colitis (Cl. difficile)
• may prolong INR in patients with low vitamin K stores
• false positive tests for galactosaemia and Coomb's test
• eosinophilia (6%), thrombocytosis (5%), leucopenia (2%), haemolytic anaemia (<1%)
• elevated LFT's (3%)
• other rare adverse effects see full PI.

• uncomplicated gonococcal disease: 150mg iv or im single dose only
• pre-op high risk abdominal surgery: 50mg/kg up to max 1g iv single dose 30-120min pre-op
• urinary tract infections (UTIs) / cystitis, pneumonia, etc: 25mg/kg up to max 1g iv daily
• severe infections: 50-75mg/kg up to max 2g iv daily
• meningitis: 50mg/kg to max 2g iv 12hrly

• dissolve 0.5g in 5ml or 1g in 10ml water for injections, administer iv over 2-4 minutes

• 2 g dissolved in approximately 40 mL 0.9% saline or other calcium free solution
• administer over at least 30 minutes

• 0.5 g dissolved in 2 mL, or 1 g in 3.5 mL, of lignocaine 1% solution, administered by deep intragluteal injection.
• no more than 1 g be injected on either side.