Antimicrobials
Ceftriaxone

Ceftriaxone

High
N/A

Dosing

General Information

Administration

  • IM injected deep into large muscle mass Intravenous
  • Do not co-administer with solutions containing calcium
  • Infuse IV over 30 minutes
  • IV push of 1g over 1-4 minutes has been reported, but, 2g push over 5 minutes resulted in tachycardia and palpitations

Preparation IM

  • Concentration of 250mg/mL or 350mg/mL recommended for all vial sizes except 250mg (must be 250mg/mL)
  • Diluted with 1:1 water or 1% lidocaine Intravenous
  • Reconstitute vials with SWFI, D5W, D10W, or NS for concentration 100mg/mL
  • Add 2.4mL to 250mg vial, 4.8mL to 500mg vial, 9.6mL to 1g vial and 19.2mL to 2g vial
  • Further dilute in 50-100mL of D5W or NS

Compatibility

  • D5W, NS

Empiric therapy of:

  • Bacterial meningitis
  • Nosocomial gram negative infections (except Pseudomonas)
  • Spontaneous bacterial peritonitis
  • Hospitalized community or nursing home acquired pneumonia in combination with a macrolide

Tier 2 Protected Antimicrobial

  • Broad spectrum, but 1st line for common infections, comes with a high risk of poor stewardship if initial workup and follow-up are not in place

Strategies Used:

  1. Appropriate workup initially
  2. Pharmacists audit/de-escalate
  3. Set EBM Duration
  • Prothrombin time/INR
  • Test of cure 7-14 days after initial treatment of pharyngeal gonorrhea
  • Renal and hepatic function periodically
  • Allergy/rash (immediate or delayed)
  • Cytopenias
  • Eosinophilia
  • Hepatic & renal laboratory abnormalities
  • Pseudocholelithiasis. Unclear clinical significance. Uncommonly symptomatic, but frequently by ultrasound gallbladder sludge
  • Calcium salts: enhance adverse effects of ceftriaxone
  • Lactated Ringer's for Injection: ceftriaxone binds calcium and forms insoluble participate
  • Alcohol: disulfuram like reaction
  • Aminoglycosides: enhanced nephrotoxicity
  • Methotrexate: enhanced adverse effects of methotrexate
  • Probenecid: increase concentration of cephalosporins
  • Vitamin K Antagonists: enhanced anticoagulant effect of warfarin

Antimicrobial class: Parenteral Cephalosporin - 3rd Generation

Pregnancy category: B

Average serum half life: 8 hours

  • Neonatal half-life 1-4 days

Urine penetration: Therapeutic, 33-67% excreted unchanged into urine

Lung penetration: Therapeutic

CSF penetration: Therapeutic, higher concentration when meninges are inflamed

Biliary penetration: Therapeutic

Bone penetration: Therapeutic

Rocephin