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Ceftriaxone
Pham P and Bartlett JG
04-17-2008
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Available formulation in Zambia: Powder for injection: 250 mg, 1 g (as sodium salt) vial.
- Good activity against S. pneumoniae, E.coli, Klebsiella, Enterobacter, Serratia and indole-positive Proteus spp.
- Complicated UTI: ceftriaxone 1 gm IV QD x 14 days in pts unable to tolerate aminoglycosides.
- Community acquired pneumonia (CAP): ceftriaxone 1 gm IV QD. If severe CAP, add erythromycin 500 mg PO q6h.
- Spontaneous bacterial peritonitis: ceftriaxone 1 gm IV QD
- GC arthritis: ceftriaxone 1 gm IV QD
- Empiric treatment of community acquired meningitis: ceftriaxone 2gm IV q12h x 10d (plus dexamethasone 10 mg IV 6h x 4 days.)
- Meningococcal meningitis prophylaxis in children: 125 mg IM x1
- Brain abscess: ceftriaxone 2gm IV q12h (plus metronidazole)
- Complicated bacterial sinusitis: ceftriaxone 2gm IV q12h
- Mastoiditis: ceftriaxone 2gm IV q12h
- Spontaneous endophthalmitis: ceftriaxone 2gm IV qd x 7 days
- Typhoid fever (S. typhi or S. paratyphi): ceftriaxone 1gm q12h
- STDs in pregnant women: ceftriaxone 125 mg IM x1 PLUS erythromycin 500 mg q6h x 7d PLUS metronidazole 400 mg bid x 7d.
Zambia Information Author: Paul A. Pham Pharm.D.
- Bacterial septicemia
- Bone, joint, skin and skin structure infections
- Gonorrhea (urethral, cervical, pharyngeal, disseminated)
- Intra-abdominal infections (with metronidazole)
- Upper respiratory tract infections (otitis media)
- Lower respiratory tract infections (CAP)
- Meningitis
- Complicated and uncomplicated urinary tract infections
-
Pelvic inflammatory disease
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Shunt infections
- Brain Abscess (with metronidazole)
- Appendicitis (with metronidazole)
- Peritonitis, Spontaneous Bacterial & Secondary
-
Endocarditis
- Diabetic Foot Infection (with metronidazole or clindamycin)
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Lyme Arthritis
- Meningococcal meningitis prophylaxis: 125 mg x1 (<15 yrs); 250 mg x1 (>15 yrs). Due to reports of fluoroquinolone resistance, rifampin, ceftriaxone, and azithromycin is recommended in selected counties in North Dakota and Minnesota (MMWR 2008; 57:173-175)
brand
name
| generic
| Mfg
| brand
forms
| cost*
|
| Rocephin | Ceftriaxone | Roche | IV
vial
250mg | $18 |
|
|
|
| IV
vial
500mg | $30 |
|
|
|
| IV
vial
1g | $51 |
|
|
|
| IV
vial
2g | $105 |
|
|
|
| IV
vial
10g | $498 |
| Ceftriaxone | Baxter | IV
vial
1g/50mL | $39 |
|
|
|
| IV
vial
2g/50mL | $69 |
*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP).
AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's
information, and the McKesson database.
^Dosage is indicated in mg unless otherwise noted.
1-2Gm IM or IV q24h (up to 4Gm max per day). Use 2Gm IV q12h for meningitis treatment.
Usual dose
Usual dose
Usual dose
1-2Gm IV q24h (No extra doses needed post dialysis)
Usual regimen
Usual dose
- Generally well tolerated.
- Pseudocholelithiasis with sludge in gallbladder by ultrasound.
- Minimal phlebitis at infusion sites
- Allergic reactions (eosinophilia). Cross-allergy to PCN lower than 1st generation cephalosporins.
-
Diarrhea and C.difficile colitis
- Positive Coombs' test
- CNS: convulsions (high dose with renal failure); confusion, disorientation, and hallucinations.
- Drug fever
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Neutropenia and thrombocytopenia
- Hepatitis
- Anaphylaxis reaction
- Hemolytic anemia
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Cholecystitis
- Interstitial nephritis
- Calcium-ceftriaxone precipitates in the lungs and kidneys in both term and premature neonates (with calcium solution co-administration).
- Warfarin: anticoagulation effect may be enhanced.
- Probenecid: increase in cephalosporin serum concentration due to inhibition of tubular secretion by probenecid.
- Calcium containing solutions: ceftriaxone should not be mixed or administered simultaneously or within 48-hours with calcium-containing solutions or products, even via different infusion lines. Consider using cefotaxime with calcium-containing solution co-administration.
Parenteral 3rd gen cephalosporin w/ convenient once a day dosing often used for outpatient IV therapy. Cefotaxime is clinically equivalent, but given q6h. Excreted via biliary and urinary tracts. May cause biliary sludging and cholecystitis. Cefotaxime and ceftriaxone are the preferred cephalosporins for serious pneumococcal infections (meningitis and pneumonia), but 1.6 to 5+% of strains are resistant.
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