Ceftriaxone (PDF Version)
Staphylococcus aureus (methicillin susceptible), Coagulase negative Staphylococci, Streptococcus pneumoniae (penicillin susceptible), Streptococcus spp., Haemophilus influenzae, Moraxella catarrhalis, Neisseria meningitides, Neisseria gonorrhoeae, Enterobacteriaceae, E. coli
Mechanism of Action:
Cephalosporins exert bactericidal activity by interfering with bacterial cell wall synthesis and inhibiting cross-linking of the peptidoglycan. The cephalosporins are also thought to play a role in the activation of bacterical cell autolysins which may contribute to bacterial cell lysis.
Cephalosporins exhibit time-dependent killing (T > MIC)
Dose of 1g: Cmax: 123-151mcg/L; Half-life: 8 hours; Volume of distribution: 10.7L; Table 11
Hypersensitivity: Maculopapular rash, Urticaria, Pruritis, Anaphylaxis/angioedema, eosinophilia
Hematologic: Hypoprothrombinemia, Neutropenia, Leukopenia, Thrombocytopenia
GI: Diarrhea, C. difficile disease
Renal: Interstitial nephritis
IV: 1g, 2g, 250mg, 500mg
Dosing in adults:
Meningitis: 2g IV q24h
Intraabdominal infections: 1-2g IV q12-24h
Pelvic inflammatory disease: 1-2g IV q12-24h
Bone and/or joint infection: 1-2g IV q12-24h
Gonorrhea: 250mg IM x 1 dose
Dosing in pediatrics:
50-100mg/kg divided q12-24h
Disease state based dosing:
Renal failure: No dosing changes recommended at this time.
Hepatic failure: No dosing changes recommended at this time.
Dosing during Continuous Renal Replacement Therapy
CVVH (Continuous venovenous hemofiltration): 2g IV q12-24h
CVVHD (Continuous venovenous hemodialysis): 2g IV q12-24h
CVVHDF (Continuous venovenous hemodiafiltration) 2g IV q12-24h
Note: CVVH is mainly for fluid removal alone. Many institutions will employ more CVVHD or CVVHDF which combine dialysis with fluid removal.
Contraindications: Hyperbilirubinemic neonates; increased risk for bilirubin encephalopathy (kernicterus)
Precautions: hypersensitivity to penicillins, history of gastrointestinal disease, particularly colitis,
Cyclosporine: an increased risk of cyclosporine toxicity (renal dysfunction, cholestasis, paresthesias)
Live Typhoid Vaccine: decreased immunological response to the typhoid vaccine
FDA: Ceftriaxone Must Not Be Co-administered with Calcium
Category B: No evidence of risk in humans but studies inadequate.
Therapeutic: Culture and sensitivities, serum levels, signs and symptoms of infection, white blood cell count
Toxic: Urinalysis, BUN, SCr, AST and ALT, skin rash, Neutropenia and leukopenia, Prothrombin time in patients with renal or hepatic impairment or poor nutritional state, as well as patients receiving a protracted course of antimicrobial therapy, and patients previously stabilized on anticoagulant therapy.
Brand names/Manufacturer: RocephinÒ/Roche