ceftroxon

Brand Name: Rocephin

Generic Name: Ceftriaxone

Drug Class: Cephalosporins, 3rd Generation

What Is Ceftriaxone and How Does It Work?

Ceftroxone is used to treat a wide variety of bacterial infections. Ceftriaxone belongs to a class of drugs known as cephalosporin antibiotics. It works by stopping the growth of bacteria.

Ceftriaxone is not recommended for use in newborns with high blood bilirubin levels and premature infants due to increased risk of side effects.

Ceftriaxone may also be used before dental procedures in people with certain heart conditions (such as artificial heart valves) to help prevent serious infections of the heart

Ceftriaxone is available under the following different brand names: rocephin 

What Are Dosages of Ceftriaxone?

Dosages of Ceftriaxone:

Adult and paediatric Dosage Forms and Strengths

Injectable solution

• 1 g/50 mL
• 2 g/50mL

Powder for injection

• 250 mg
• 500 mg
• 1 g
• 2 g
• 10 g (adult only)
• 100 g (adult only)

Dosage Considerations – Should be Given as Follows:

Intra-abdominal  Infections

• Complicated, mild-to-moderate, community-acquired 1-2 g/day intravenously (IV) in single daily dose or divided every 12 hours for 4-7 days, in combination with metronidazole

• Adult: 50 mg/kg intramuscularly (IM) once
• Persistent or treatment failures: 50 mg/kg intravenously/intramuscularly (IV/IM) for 3 days
• Pediatric: 50 mg/kg IM in single-dose; not to exceed 1 

• 250 mg intramuscularly (IM) as a single dose with doxicyline, with or without metronidazole for 14 days
• Due to Aeromonas hydrophilia: 1-2 g intravenously (IV) once/day in combination with doxycycline
• Due to Vibrio vulnificus; 1 g IV once/day in combination with doxycycline
• Continue treatment until further debridement is not necessary, the clinical improvement observed, and the patient is afebrile for 48-72 hours
• Children over 12 years: 1-2 g/day intravenously/intramuscularly (IV/IM) in a single daily dose or divided every 12 hours for 7-14 days, depending on type and severity of infection

Severe Acute Bacterial Rhinosinusitis (Off-label)

• Infection requiring hospitalization: 1-2 g intravenously (IV) every 12-24 hours for 5-7 days

Prosthetic joint Infection

• 2 g intravenously (IV) every 24 hours for 2-6 weeks; continue treatment until clinical improvement is observed and the patient is afebrile for 48-72 hours

• Adult: 2 g intravenously (IV) every 12 hours for 7-14 days
• Pediatric: 100 mg/kg/day intravenously/intramuscularly (IV/IM) in single daily dose or divided every 12 hours for 7-14 days; not to exceed 4 g/day


• Serious Infections Other Than Meningitis, Pediatric
• 50-75 mg/kg/day intravenously/intramuscularly (IV/IM) divided every 12 hours for 7-14 days

Adult: Uncomplicated gonococcal infection of pharynx, cervix, urethra, or rectum: ceftriaxone 250 mg intramuscularly (IM) once plus Azithromycin1 g orally once (preferred) or alternatively, doxycycline 100 mg orally every 12 hours for 7 days

Sexual assault

• Prophylaxis of sexually transmitted diseases (STDs) such as gonorrhoea after sexual assault per CDC guidelines includes the following 3-drug regimen:
  • Ceftriaxone 250 mg intramuscularly (IM) once, PLUS
  • Azithromycin 1 g orally once, PLUS
  • Metronidazole or tinidazole 2 g orally once
  • If alcohal has been recently ingested or emergency contraception is provided, metronidazole or tinidazole can be taken by the victim at home rather than as directly observed threpy to avoid drug interactions

Pediatric:

Neonates

• Ophthalmolmia neonatorum: 25-50 mg/kg intravenously/intramuscularly (IV/IM) once; not to exceed 125 mg
• Disseminated gonococcal infections and gonococcal scalp abscesses: 25-50 mg/kg/day IV/IM in single daily dose for 7 days; if meningitis is documented, treat for 10-14 days
• Prophylaxis for infants of mothers with gonococcal infection: 25-50 mg/kg IV/IM once; not to exceed 125 mg

Children

• Less than 45 kg with uncomplicated gonococcal vulvovaginitis, cervicitis, urethritis, pharyngitis, or proctitis: 125 mg intramuscularly (IM) once
• Less than 45 kg with bacteremia or arthritis: 50 mg/kg/day intravenously/intramuscularly (IV/IM) in single daily dose for 7 days; daily dose not to exceed 1 g
• Greater than 45 kg with bacteremia or arthritis: 50 mg/kg/day IM/IV in single daily dose for 7 days
• Greater than 45 kg: 1-2 g intravenously (IV) every 12 hours

Other Gonococcal Infections (Off-label)

• Gonococcal conjunctivitis: 1 g intramuscularly (IM) once
• Disseminated gonococcal infection: 1 g/day intravenously/intramuscularly (IV/IM); continued for at least 24-48 hours after improvement is observed, then continued with cefixime 400 mg orally every 12 hours to complete at least 1 week of therapy
• Gonococcal endocarditis: 1-2 g intravenously (IV) every 12 hours for 4 weeks
• Gonococcal meningitis: 1-2 g IV every 12 hours for 10-14 days
• Acute epididymitis: 250 mg IM once with doxycycline

Epiglottis, Pediatric (Off-label)

• 100 mg/kg/day intravenously (IV) on first day; follow with 50 mg/kg on day 2 or 75 mg/kg once/day for 10-14 days

Acute Epididymitis, Pediatric (Off-label)

• Children over 8 years and greater than 45 kg: 250 mg intramuscularly (IM) once with concomitant doxycycline regimen

Dosing Considerations

Susceptible organisms

• Anaerobic cocci, Bacteroides fragilis, Borrelia burgdorferi, Clostridium spp, Enterobacter spp, Escherichia coli, Haemophilus influenzae, Klebsiella spp, Morganella morganii, Neisseria gonorrhoeae, Neisseria meningitides, Proteus mirabilis, Providencia rettgeri, Pseudomonas spp, Serratia spp, Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes

What Are Side Effects Associated with Using Ceftriaxone?

Common side effects of ceftriaxone include:

• Injection site reactions (swelling, redness, pain  a hard lump, or soreness)
• Eosinophilia
• Increased blood 
• platelets(thrombocytos
  
• Diarrhea
• Elevated liver transaminases
• Low white blood cell count (leukopenia)
• Rash
• Increased blood urea nitrogen
• Pain

Less common side effects of ceftriaxone include:

• Agranulocytosis
• Animea
• Basophilia
• Blood in the urine
• Bronchospasm
• Changes in taste
• Chills
• Dizziness
• Excess sweating
• Flushing
• Gallastone
• Headache
• Hemolytic anemia
• Increase in lymphocytes in the blood (lymphocytosis
• Increase in monocytes in the blood (monocytosis)
• Increase in white blood cells (leucocytosis)
• Increased alkaline phosphatase or bilirubin
• Increased creatinine
• Itching
• Loss of appetite
• Low levels of lymphocytes in the blood (lymphopenia)
• Low platelets thrombocytopenia)
• Low WBC count (neutropenia)
• Nausea
• Overactive reflexes
• Pain or swelling in your tongue
• Phlebitis
• Prolonged or decreased prothombin time(PT)
• Renal stones
• Serum sickness
• Severe allergic reaction
• Sugar in the urine
• Upset stomach
• Urinary casts
• Vaginal itching or 
• Vomiting
• Vomiting
• Yeast infections
• Yellowing skin and eyes (jaundice

Mild interactions of ceftriaxone include:

• choline magnesium trisalicylat
• Rose hips
• willow bark

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns or for more information about this medicine.

What Are Warnings and Precautions for Ceftriaxone?

Warnings

This medication contains ceftriaxone. Do not take Rocephin if you are allergic to ceftriaxone or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose.

Contraindications

• Documented hypersensitivity; hyperbilirubinemic neonates, particularly those who are premature; neonates under 28 days if they receive calcium-containing intravenous (IV) products.
• Intravenous administration of ceftriaxone solutions containing lidocaine
• Lidocaine contraindications if lidocaine solution used as solvent with ceftriaxone for intramuscular injection.
• Concomitant calcium-ceftriaxone administration:
• Risk of fatal calcium-ceftriaxone precipitant formation in lungs and kidneys of term and preterm neonates
• Infants under 28 days: Do not give any calcium-containing IV drugs or products within 48 hours of ceftriaxone (within 5 days if neotic is under 10 days, per Health Canada)
• Infants over 28 days: Calcium may be given in sequence after ceftriaxone once infusion line has been flushed, but not simultaneously in same bag or line (chemically incompatible)

Effects of Drug Abuse

• None

Short-Term Effects

• See "What Are Side Effects Associated with Using Ceftriaxone?"

Long-Term Effects

• See "What Are Side Effects Associated with Using Ceftriaxone?"

Cautions

• 10-g pharmacy bulk package should not be used for direct infusion
• Immune-mediated hemilytic  anemia reported; if patient develops anemia while on ceftriaxone, 
• Use with caution in patients with history of peniciline allergy
• Use with caution in patients with history of gastrointestinal disease, especially colitis
• Use with caution in breastfeeding women; drug may displace bilirubin from albumin binding sites, increasing risk of kernicterus
• Abnoal gallbladder sonograms reported, possibly the result of ceftriaxone-calcium precipitates; discontinue if signs or symptoms of gallbladder disease occur
• Pancreatitis secondary to biliary obstruction reported rarely; use with caution in patients with gallbladder, biliary tract, liver, or pancreatic disease and patients with history of penicillin hypersensitivity
• Use with caution in patients with history of gastrointestinal (GI) disease (e.g., colitis)

Pregnancy 

• Ceftriaxone may be acceptable for use during pregnancy. Either animal studies show no risk but human studies are not available or animal studies showed minor risks and human studies were done and showed no risk
• Ceftriaxone enters breast milk in low concentrations. Use with caution in breastfeeding women. Ceftriaxone may displace bilirubin from albumin-binding sites,