Ceftriaxone

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General

  • Type: 3rd generation Cephalosporin
  • Dosage Forms: IM, IV
  • 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
  • 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

  • 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

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]

Group Organism 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

  • 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

  1. Sanford Guide to Antimicrobial Therapy 2014