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Ceftriaxone

Medical and Pharmacy Editor:

Brand Name: Rocephin

Generic Name: Ceftriaxone

Drug Class: Cephalosporins, 3rd Generation

What Is Ceftriaxone and How Does It Work?

Ceftriaxone 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. Ask the doctor or pharmacist for details.

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

Ceftriaxone is available under the following different brand names: Rocephin.

Dosages of Ceftriaxone:

Adult and Pediatric 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

Acute Bacterial Otitis Media

  • 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 g

Pelvic Inflammatory Disease

  • 250 mg intramuscularly (IM) as single dose with doxycycline, with or without metonidazole for 14 days

Septic/toxic Shock (Off-label)

Skin and Soft Necrotizing Infection (Off-label)

  • 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 not necessary, clinical improvement observed, and patient is afebrile for 48-72 hours
  • Children over 12 years: 1-2 g/day intravenously/intramuscularly (IV/IM) in 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 observed and patient is afebrile for 48-72 hours

Meningitis

  • 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

Acute Uncomplicated Pyelonephritis

  • 1-2 g intravenously (IV) once/day

Surgical Prophylaxis

Prophylaxis of surgical infection

  • 1 g intravenously (IV) 0.5-2 hours before procedure

Uncomplicated Gonococcal Infections

Adult: Uncomplicated gonococcal infection of pharynx, cervix, urethra, or rectum: ceftriaxone 250 mg intramuscularly (IM) once plus azithromycin 1 g orally once (preferred) or alternatively, doxycycline 100 mg orally every 12 hours for 7 days

Centers for Disease Control (CDC) Sexually Transmitted Diseases (STD) guidelines: MMWR Recommendations Rep. June 5, 2015:64(RR3);1-137

Sexual assault

  • Prophylaxis of sexually transmitted diseases (STDs) such as gonorrhea 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 alcohol 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 therapy to avoid drug interactions

Pediatric:

Neonates

  • Ophthalmia 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 epdidymitis: 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 Epdidymitis, 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 meningitidis, Proteus mirabilis, Providencia rettgeri, Pseudomonas spp, Serratia spp, Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes
Medically Reviewed by a Doctor on 8/15/2017



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