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
Images: Related links to external sites (from Bing)
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 |
Ontology: Ceftriaxone (C0007561)
| Definition (CHV) | a kind of antibiotics |
| Definition (NCI_NCI-GLOSS) | An antibiotic drug used to treat infection. It belongs to the family of drugs called cephalosporin antibiotics. |
| Definition (NCI) | A beta-lactam, third-generation cephalosporin antibiotic with bactericidal activity. Ceftriaxone binds to and inactivates penicillin-binding proteins (PBP) located on the inner membrane of the bacterial cell wall. PBPs participate in the terminal stages of assembling the bacterial cell wall, and in reshaping the cell wall during cell division. Inactivation of PBPs interferes with the cross-linkage of peptidoglycan chains necessary for bacterial cell wall strength and rigidity. This results in the weakening of the bacterial cell wall and causes cell lysis. Compared to the second and first generation cephalosporins, ceftriaxone is more active against gram-negative bacteria and less active against gram-positive bacteria. Ceftriaxone also crosses the blood-brain barrier and reaches therapeutic concentrations in the central nervous system (CNS). |
| Definition (MSH) | A broad-spectrum cephalosporin antibiotic with a very long half-life and high penetrability to meninges, eyes and inner ears. |
| Concepts | Antibiotic (T195) , Organic Chemical (T109) |
| MSH | D002443 |
| SnomedCT | 19841008, 372670001 |
| LNC | LP15260-0, MTHU004608 |
| English | Cefatriaxone, Ceftriaxon, Ceftriaxone, 5-Thia-1-azabicyclo(4.2.0)oct-2-ene-2-carboxylic acid, 7-(((2-amino-4-thiazolyl)(methoxyimino)acetyl)amino)-8-oxo-3-(((1,2,5,6-tetrahydro-2-methyl-5,6-dioxo-1,2,4-triazin-3-yl)thio)methyl)-, (6R-(6alpha,7beta(Z)))-, ceftriaxone (medication), Ceftriaxone [Chemical/Ingredient], CEFTRIAXONE, cefTRIAXone, ceftriaxone, Ceftriaxone (product), Ceftriaxone (substance) |
| Swedish | Ceftriaxon |
| Czech | ceftriaxon |
| Finnish | Keftriaksoni |
| Russian | TSEFTRIAKSON, ЦЕФТРИАКСОН |
| Japanese | セフトリアキソン, ロセフィン, セフトリアキソンナトリウム |
| Croatian | CEFTRIAKSON |
| Polish | Ceftriakson |
| Spanish | ceftriaxona (producto), ceftriaxona (sustancia), ceftriaxona, Ceftriaxona |
| French | Ceftriaxone |
| German | Ceftriaxon |
| Italian | Ceftriaxone |
| Portuguese | Ceftriaxona |
Ontology: Rocephin (C0035750)
| Concepts | Antibiotic (T195) , Organic Chemical (T109) |
| MSH | D002443 |
| English | Rocefin, ceftriaxone (Rocephin), rocefin, rocephin, Rocephin, Hoffman La Roche Brand of Ceftriaxone Sodium, Hoffman-La Roche Brand of Ceftriaxone Sodium, Rocefalin, Rocephine, Roche Brand of Ceftriaxone Sodium |
