II. Indications
- Pneumonia
- Pyelonephritis
- Pelvic Inflammatory Disease
- Sepsis
- Meningitis
- Skin and Soft Tissue Infections
- Bone and Joint Infections
- Intraabdominal infections
- Gonorrhea
- Lyme Disease
- Chancroid
- Typhoid Fever
III. Contraindications
- Newborns
- Kernicterus risk in age <7-14 days
- Some studies have shown safety in term infants with inconjugated Hyperbilirubinemia
IV. Mechanism
- See Third Generation Broad-Spectrum Cephalosporin
- Ceftriaxone has less Staphylococcus and Anaerobic activity than Cefotaxime
- Frequently used with Metronidazole (e.g. Intraabdominal infections, Pelvic Inflammatory Disease)
V. Dosing
- Background
- Dilute in Lidocaine 1% for Intramuscular Injection (risk of Methemoglobinemia)
- Child
- Standard
- Give 50-75 mg/kg/day (max 2 g/day) IV or IM divided every 12-24 hours
- Meningitis
- Give 100 mg/kg/day (max 4 g/day) IV divided every 12-24 hours (twice daily is preferred)
- Otitis Media
- Give 50 mg/kg IM single dose (max 1 g)
- Standard
- Adult
- See Gonorrhea (and other specific indications listed above)
- Standard
- Give 1 to 2 grams IM or IV every 24 hours
- In adults, 2 gram dose is preferred in >100 kg or critically ill patients
- Maximum
- Typical Maximum: 4 g/day divided every 12 hours
- Lower Maximum: 2 g/day
- Elderly
- Hepatic dysfunction
- Renal Dysfunction
VI. Adverse Effects
- Biliary disease exacerbation (e.g. Biliary Colic)
- Ceftriaxone is excreted in bile and displaces Bilirubin from albumin binding
- Risk of acalculous cholestasis
VII. Safety
- Pregnancy Category B
- Safe in Lactation
VIII. Drug Interactions
-
Prothrombin Time or INR
- Increased prothombin time
-
Intravenous Calcium or Calcium Containing Solutions (e.g. LR, Hartmann's Solution, TPN)
- Risk of Ceftriaxone and Calcium preciptation
- Precipitation is also associated with lethal lung and Renal Injury in newborns
IX. Resources
X. References
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- (2012) Presc Lett, Resource #280706, Comparison of Cephalosporins
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Related Studies
| ceftriaxone (on 6/22/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| CEFTRIAXONE 1 GM VIAL | Generic | $1.83 each |
| CEFTRIAXONE 500 MG VIAL | Generic | $0.97 each |