Ceftriaxone: Difference between revisions
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==General== | ==General== | ||
*Type: 3rd generation [[ | *Type: {{#set:cephalosporin generation =3rd}} 3rd generation [[Antibiotic class::Cephalosporin]] | ||
*Dosage Forms: | *Dosage Forms: injectable solution, powder for injection | ||
*Dosage Strengths: injectable solution: 1g/50mL, 2g/50mL; powder for injection: 250mg, 500mg, 1g, 2g, 10g, 100g | |||
*Routes of Administration: IV, IM | |||
*Common Trade Names: Rocephin | *Common Trade Names: Rocephin | ||
Line 7: | Line 9: | ||
===General=== | ===General=== | ||
*1-2g IM/IV q24h | *1-2g IM/IV q24h | ||
**Max: 4g/24h | *First ED Dose: 1g IM/IV x 1 | ||
*Max: 4g/24h | |||
===Bacterial [[Meningitis]]=== | ===Bacterial [[Meningitis]]=== | ||
*4g IV divided q12-24h x 7-21 days | *4g IV divided q12-24h x 7-21 days | ||
*First ED Dose: 2g IM/IV x 1 | |||
===[[Gonococcal]]=== | ===[[Gonococcal]]=== | ||
Line 33: | Line 37: | ||
**30-60 min before procedure | **30-60 min before procedure | ||
===[[Proctitis]] | ===[[Proctitis]], [[Epididymitis]], [[Chancroid]]=== | ||
*250mg IM x 1 | *250mg IM x 1 | ||
**Give with doxycycline | **Give with doxycycline | ||
Line 44: | Line 44: | ||
*1g IV x 1 | *1g IV x 1 | ||
**Give 0.5-2h preop | **Give 0.5-2h preop | ||
===[[Typhoid Fever]]=== | ===[[Typhoid Fever]]=== | ||
*60mg/kg IV q24h x 2wk | *60mg/kg IV q24h x 2wk | ||
*Max: 4g/24h | |||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
===General (<7 Days Old)=== | |||
*50mg/kg IM/IV q24h | |||
*First Dose: 50mg/kg IM/IV x 1 | |||
===General (7 Days - 1 Month)=== | |||
*<2000g | |||
**50mg/kg IM/IV q24h | |||
**First Dose: 50mg/kg IM/IV x 1 | |||
*>2000g | |||
**50-75mg/kg IM/IV q24h | |||
**First Dose: 50-75mg/kg IM/IV x 1 | |||
===General (>1 Month - Adult)=== | |||
*50-100mg/kg IM/IV divided q12-24h | |||
*First Dose: 50-100mg/kg IM/IV x 1 | |||
*Max: 4g/24h | |||
===Acute [[Otitis Media]] (2 Months - 12 Years)=== | |||
*50mg/kg IM/IV x 1 | |||
*Give 50mg/kg IM/IV q24h x 3 days for recurrent infection | |||
*Max 1g/dose | |||
===Bacterial [[Meningitis]]=== | |||
*80-100mg/kg IV divided q12-24h x 7-21 days | |||
*First Dose: 100mg/kg IV x 1 | |||
*Max: 4g/24h | |||
===[[Pneumonia]], Community-Acquired (>3 Months)=== | |||
*50-100mg/kg/day IM/IV divided q12-24h x 10 days | |||
*First Dose: | |||
*Max: 2g/day | |||
*Info: May switch to PO when possible to complete course | |||
==Special Populations== | |||
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: B | |||
*Lactation: Probably safe | |||
*Renal Dosing | |||
**Adult | |||
***Renal failure: No initial adjustment, monitor serum levels | |||
***Hemodialysis: give dose after dialysis, no supplement | |||
***Peritoneal Dialysis: 750mg q12h | |||
**Pediatric | |||
***CrCl <10: give q24h | |||
***Hemodialysis: 50mg/kg q24, no supplement | |||
***Peritoneal Dialysis: 50mg/kg q24, no supplement | |||
*Hepatic Dosing | |||
**Adult | |||
***Hepatic and renal disease: max 2g/day, unless closely monitoring serum levels | |||
**Pediatric | |||
***May requrire dose adjustment but specific dosing not defined | |||
==Contraindications== | ==Contraindications== | ||
*Allergy to class/drug | *Allergy to class/drug (see also [[Cephalosporin Cross-reactivity]]) | ||
*Patients <1 month old | |||
**Hyperbillirubinemia | |||
**IV calcium containing product | |||
**If a 3rd generation cephalosporin is required, consider using Cefotaxime instead | |||
==Adverse Reactions== | ==Adverse Reactions== | ||
===Serious=== | |||
*[[Anaphylaxis]] | |||
*Broncospasm | |||
*[[Stevens-Johnson Syndrome]] | |||
*[[Toxic Epidermal Necrolysis]] | |||
*Erythema multiforme | |||
*Serum sickness | |||
*Pneumonitis | |||
*Neutropenia | |||
*Leukopenia | |||
*Hemolytic anemia | |||
*[[Thrombocytopenia]] | |||
*Hypoprothrombinemia | |||
*Agranulocytosis | |||
*Superinfection | |||
*[[Clostridium difficile]] | |||
*Colitis | |||
*Billiary/gallbladder sludge | |||
*[[Jaundice]] | |||
*[[Pancreatitis]] | |||
*[[Seizures]] | |||
*[[Nephrolithiasis]] | |||
*Lung/kidney calcium precipitate (neonates) | |||
===Common=== | |||
*Local infection site reaction | |||
*Eosinophilia | |||
*Thrombocytosis | |||
*Transaminitis | |||
*[[Diarrhea]] | |||
*Leukopenia | |||
==Pharmacology== | ==Pharmacology== | ||
Line 66: | Line 147: | ||
*Mechanism of Action: bactericidal; inhibits cell wall synthesis | *Mechanism of Action: bactericidal; inhibits cell wall synthesis | ||
== | ==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>== | ||
{| class="wikitable" | |||
| align="center" style="background:#f0f0f0;"|'''Group''' | |||
| align="center" style="background:#f0f0f0;"|'''Organism''' | |||
| align="center" style="background:#f0f0f0;"|'''Sensitivity''' | |||
|- | |||
| Gram Positive||[[Strep. Group A, B, C, G]]||'''S''' | |||
|- | |||
| ||[[Strep. Pneumoniae]]||'''S''' | |||
|- | |||
| ||[[Viridans strep]]||'''S''' | |||
|- | |||
| ||Strep. anginosus gp||X1 | |||
|- | |||
| ||[[Enterococcus faecalis]]||R | |||
|- | |||
| ||[[Enterococcus faecium]]||X1 | |||
|- | |||
| ||[[MSSA]]||'''S''' | |||
|- | |||
| ||[[MRSA]]||R | |||
|- | |||
| ||[[CA-MRSA]]||R | |||
|- | |||
| ||[[Staph. Epidermidis]]||I | |||
|- | |||
| ||[[C. jeikeium]]||R | |||
|- | |||
| ||[[L. monocytogenes]]||R | |||
|- | |||
| Gram Negatives||[[N. gonorrhoeae]]||I | |||
|- | |||
| ||[[N. meningitidis]]||'''S''' | |||
|- | |||
| ||[[Moraxella catarrhalis]]||'''S''' | |||
|- | |||
| ||[[H. influenzae]]||'''S''' | |||
|- | |||
| ||[[E. coli]]||'''S''' | |||
|- | |||
| ||[[Klebsiella]] sp||'''S''' | |||
|- | |||
| ||E. coli/Klebsiella ESBL+||R | |||
|- | |||
| ||E coli/Klebsiella KPC+||R | |||
|- | |||
| ||[[Enterobacter]] sp, AmpC neg||'''S''' | |||
|- | |||
| ||[[Enterobacter]] sp, AmpC pos||R | |||
|- | |||
| ||[[Serratia]] sp||'''S''' | |||
|- | |||
| ||Serratia marcescens||X1 | |||
|- | |||
| ||[[Salmonella]] sp||'''S''' | |||
|- | |||
| ||[[Shigella]] sp||'''S''' | |||
|- | |||
| ||[[Proteus mirabilis]]||'''S''' | |||
|- | |||
| ||[[Proteus vulgaris]]||'''S''' | |||
|- | |||
| ||[[Providencia sp.]]||'''S''' | |||
|- | |||
| ||[[Morganella sp.]]||'''S''' | |||
|- | |||
| ||[[Citrobacter freundii]]||'''S''' | |||
|- | |||
| ||[[Citrobacter diversus]]||'''S''' | |||
|- | |||
| ||[[Citrobacter sp.]]||'''S''' | |||
|- | |||
| ||[[Aeromonas sp]]||'''S''' | |||
|- | |||
| ||[[Acinetobacter sp.]]||R | |||
|- | |||
| ||[[Pseudomonas aeruginosa]]||R | |||
|- | |||
| ||[[Burkholderia cepacia]]||I | |||
|- | |||
| ||[[Stenotrophomonas maltophilia]]||R | |||
|- | |||
| ||[[Yersinia enterocolitica]]||'''S''' | |||
|- | |||
| ||[[Francisella tularensis]]||X1 | |||
|- | |||
| ||[[Brucella sp.]]||X1 | |||
|- | |||
| ||[[Legionella sp.]]||R | |||
|- | |||
| ||[[Pasteurella multocida]]||'''S''' | |||
|- | |||
| ||[[Haemophilus ducreyi]]||'''S''' | |||
|- | |||
| ||[[Vibrio vulnificus]]||X1 | |||
|- | |||
| Misc||[[Chlamydophila sp]]||X1 | |||
|- | |||
| ||[[Mycoplasm pneumoniae]]||X1 | |||
|- | |||
| ||[[Rickettsia sp]]||X1 | |||
|- | |||
| ||[[Mycobacterium avium]]||X1 | |||
|- | |||
| Anaerobes||[[Actinomyces]]||'''S''' | |||
|- | |||
| ||[[Bacteroides fragilis]]||R | |||
|- | |||
| ||[[Prevotella melaninogenica]]||I | |||
|- | |||
| ||[[Clostridium difficile]]||X1 | |||
|- | |||
| ||[[Clostridium (not difficile)]]||'''S''' | |||
|- | |||
| ||[[Fusobacterium necrophorum]]||X1 | |||
|- | |||
| ||[[Peptostreptococcus sp.]]||'''S''' | |||
|} | |||
===Key=== | |||
{{Template:Antibacterial Spectra Key}} | |||
==See Also== | ==See Also== | ||
*[[Antibiotics (Main)]] | *[[Antibiotics (Main)]] | ||
== | ==References== | ||
<references/> | |||
[[Category: | [[Category:Pharmacology]] |
Revision as of 18:21, 13 October 2017
General
- Type: 3rd generation Cephalosporin
- Dosage Forms: injectable solution, powder for injection
- Dosage Strengths: injectable solution: 1g/50mL, 2g/50mL; powder for injection: 250mg, 500mg, 1g, 2g, 10g, 100g
- Routes of Administration: IV, IM
- Common Trade Names: Rocephin
Adult Dosing
General
- 1-2g IM/IV q24h
- First ED Dose: 1g IM/IV x 1
- Max: 4g/24h
Bacterial Meningitis
- 4g IV divided q12-24h x 7-21 days
- First ED Dose: 2g IM/IV x 1
Gonococcal
- Uncomplicated, initial: 250mg IM x 1
- Also treat for chlamydia regardless of test results
- Uncomplicated, recurrent of persistent: 500-1000mg IM x 1
- Disseminated: 1g IM/IV q24h
- May switch to cefixime PO after 24-48h if clinical improvement
- Conjunctivitis: 1g IM x 1
- Prophylaxis (sexual assault victims)
- 250mg IM x 1
PID
- 250mg IM x 1
- Use with doxycycline +/- metronidazole
Sinusitis, Severe
- 1-2g IV q12-24h x 7-10 days
Endocarditis
- 1g IM/IV x 1
- 30-60 min before procedure
Proctitis, Epididymitis, Chancroid
- 250mg IM x 1
- Give with doxycycline
Surgical Prophylaxis
- 1g IV x 1
- Give 0.5-2h preop
Typhoid Fever
- 60mg/kg IV q24h x 2wk
- Max: 4g/24h
Pediatric Dosing
General (<7 Days Old)
- 50mg/kg IM/IV q24h
- First Dose: 50mg/kg IM/IV x 1
General (7 Days - 1 Month)
- <2000g
- 50mg/kg IM/IV q24h
- First Dose: 50mg/kg IM/IV x 1
- >2000g
- 50-75mg/kg IM/IV q24h
- First Dose: 50-75mg/kg IM/IV x 1
General (>1 Month - Adult)
- 50-100mg/kg IM/IV divided q12-24h
- First Dose: 50-100mg/kg IM/IV x 1
- Max: 4g/24h
Acute Otitis Media (2 Months - 12 Years)
- 50mg/kg IM/IV x 1
- Give 50mg/kg IM/IV q24h x 3 days for recurrent infection
- Max 1g/dose
Bacterial Meningitis
- 80-100mg/kg IV divided q12-24h x 7-21 days
- First Dose: 100mg/kg IV x 1
- Max: 4g/24h
Pneumonia, Community-Acquired (>3 Months)
- 50-100mg/kg/day IM/IV divided q12-24h x 10 days
- First Dose:
- Max: 2g/day
- Info: May switch to PO when possible to complete course
Special Populations
- Pregnancy Rating: B
- Lactation: Probably safe
- Renal Dosing
- Adult
- Renal failure: No initial adjustment, monitor serum levels
- Hemodialysis: give dose after dialysis, no supplement
- Peritoneal Dialysis: 750mg q12h
- Pediatric
- CrCl <10: give q24h
- Hemodialysis: 50mg/kg q24, no supplement
- Peritoneal Dialysis: 50mg/kg q24, no supplement
- Adult
- Hepatic Dosing
- Adult
- Hepatic and renal disease: max 2g/day, unless closely monitoring serum levels
- Pediatric
- May requrire dose adjustment but specific dosing not defined
- Adult
Contraindications
- Allergy to class/drug (see also Cephalosporin Cross-reactivity)
- Patients <1 month old
- Hyperbillirubinemia
- IV calcium containing product
- If a 3rd generation cephalosporin is required, consider using Cefotaxime instead
Adverse Reactions
Serious
- Anaphylaxis
- Broncospasm
- Stevens-Johnson Syndrome
- Toxic Epidermal Necrolysis
- Erythema multiforme
- Serum sickness
- Pneumonitis
- Neutropenia
- Leukopenia
- Hemolytic anemia
- Thrombocytopenia
- Hypoprothrombinemia
- Agranulocytosis
- Superinfection
- Clostridium difficile
- Colitis
- Billiary/gallbladder sludge
- Jaundice
- Pancreatitis
- Seizures
- Nephrolithiasis
- Lung/kidney calcium precipitate (neonates)
Common
- Local infection site reaction
- Eosinophilia
- Thrombocytosis
- Transaminitis
- Diarrhea
- Leukopenia
Pharmacology
- Half-life: 5.8-8.7h, 15h (CrCl 5-15)
- Metabolism: CYP450
- Excretion: Primarily urine
- Mechanism of Action: bactericidal; inhibits cell wall synthesis
Antibiotic Sensitivities[1]
Key
- S susceptible/sensitive (usually)
- I intermediate (variably susceptible/resistant)
- R resistant (or not effective clinically)
- S+ synergistic with cell wall antibiotics
- U sensitive for UTI only (non systemic infection)
- X1 no data
- X2 active in vitro, but not used clinically
- X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
- X4 active in vitro, but not clinically effective for strep pneumonia
See Also
References
- ↑ Sanford Guide to Antimicrobial Therapy 2014