Ceftriaxone

Indications & Dose:

Community-acquired pneumonia

Hospital-acquired pneumonia

Intra-abdominal infections

Complicated

urinary-tract infections

Acute exacerbations of chronic obstructive pulmonary disease

• BY INTRAVENOUS INFUSION, OR BY INTRAVENOUS INJECTION, OR BY DEEP INTRAMUSCULAR INJECTION

Adult: 1–2 g once daily, 2 g dose to be used for hospital-acquired pneumonia and severe cases

Complicated skin and soft tissue infections | Infections of bones and joints 

• BY INTRAVENOUS INFUSION, OR BY INTRAVENOUS INJECTION, OR BY DEEP INTRAMUSCULAR INJECTION

Adult: 2 g once daily Suspected bacterial infection in neutropenic patients 

• BY INTRAVENOUS INFUSION, OR BY INTRAVENOUS INJECTION, OR BY DEEP INTRAMUSCULAR INJECTION

Adult: 2–4 g once daily, doses at the higher end of the recommended range used in severe cases

Bacterial meningitis

Bacterial endocarditis

• BY INTRAVENOUS INFUSION, OR BY INTRAVENOUS INJECTION, OR BY DEEP INTRAMUSCULAR INJECTION

Adult: 2–4 g once daily, doses at the higher end of the recommended range used in severe cases 

• BY INTRAVENOUS INFUSION

Child 1 month–11 years (body-weight up to 50 kg): 80–100 mg/kg once daily, 100 mg/kg once daily dose should be used for bacterial endocarditis; maximum 4 g per day

Child 9–11 years (body-weight 50 kg and above)2–4 g once daily, doses at the higher end of the recommended range used in severe cases

Child 12–17 years: 2–4 g once daily, doses at the higher end of the recommended range used in severe cases 

• BY INTRAVENOUS INJECTION

Child 9–11 years (body-weight 50 kg and above): 2–4 g once daily, doses at the higher end of the recommended range used in severe cases

Child 12–17 years: 2–4 g once daily, doses at the higher end of the recommended range used in severe cases

• BY DEEP INTRAMUSCULAR INJECTION

Child 1 month–11 years (body-weight up to 50 kg): 80–100 mg/kg once daily, 100 mg/kg once daily dose should be used for bacterial endocarditis; maximum 4 g per day

Child 9–11 years (body-weight 50 kg and above): 2–4 g once daily, doses at the higher end of the recommended range used in severe cases

Child 12–17 years: 2–4 g once daily, doses at the higher end of the recommended range used in severe cases

Surgical prophylaxis 

• BY INTRAVENOUS INFUSION, OR BY INTRAVENOUS INJECTION, OR BY DEEP INTRAMUSCULAR INJECTION

Adult: 2 g for 1 dose, dose to be administered 30–90 minutes before procedure

Uncomplicated gonorrhoea | Pelvic inflammatory disease

•  BY DEEP INTRAMUSCULAR INJECTION

Adult: 500 mg for 1 dose

Syphilis 

• BY INTRAVENOUS INFUSION, OR BY INTRAVENOUS INJECTION, OR BY DEEP INTRAMUSCULAR INJECTION

Adult: 0.5–1 g once daily for 10–14 days, dose increased to 2 g once daily for neurosyphilis Disseminated Lyme borreliosis (early [Stage II] and late [Stage III]) 

• BY INTRAVENOUS INFUSION, OR BY INTRAVENOUS INJECTION, OR BY DEEP INTRAMUSCULAR INJECTION

Adult: 2 g once daily for 14–21 days, the recommended treatment durations vary and national or local guidelines should be taken into consideration

Prevention of secondary case of meningococcal meningitis 

• BY INTRAMUSCULAR INJECTION

Adult: 250 mg for 1 dose

Prevention of secondary case of Haemophilus influenzae type b disease 

• BY INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS INJECTION, OR BY INTRAVENOUS INFUSION

Adult: 1 g daily for 2 days

Acute otitis media 

• BY DEEP INTRAMUSCULAR INJECTION

Adult: 1–2 g for 1 dose, dose can be given for 3 days if severely ill or previous therapy failed 

History of hypercalciuria . history of kidney stones

Contraindications:

Side Effects:

 Common or very common Calcium ceftriaxone precipitates in gall bladder—consider discontinuation if symptomatic. calcium ceftriaxone precipitates in urine (particularly in very young, dehydrated or those who are immobilised)— consider discontinuation if symptomatic

Uncommon Gential fungal infection

Rare Bronchospasm . glycosuria . haematuria . prolongation of prothrombin time 

Frequency not known Convulsion . glossitis . oliguria . pancreatitis . stomatitis . toxic epidermal necrolysis . vertigo

 PREGNANCY Manufacturer advises use only if benefit outweighs risk—limited data available but not known to be harmful in animal studies. Specialist sources indicate suitable for use in pregnancy.

 BREAST FEEDING Specialist sources advise ceftriaxone is compatible with breastfeeding— present in milk in low concentration but limited effects to breast-fed infant.

RENAL IMPAIRMENT Manufacturer advises reduce dose and monitor efficacy in patients with severe renal impairment in combination with hepatic impairment—no information available.

In adults Manufacturer advises reduce dose if eGFR less than 10 mL/minute/1.73m2 (max. 2 g daily).

In children Manufacturer advises reduce dose if estimated glomeruler filtration rate less than 10 mL/minute/1.73m2 max. 50 mg/kg daily or max. 2 g daily).

Cautions:

 SPECIFIC CAUTIONS 

With intravenous use concomitant treatment with intravenous calcium (including total parenteral nutrition containing calcium) (in adults)

Precautions:

Interaction:

Drugs

Aminoglycosides: Additive nephrotoxicity

Loop diuretics: Increased nephrotoxicity

Warfarin: Hypoprothrombinemic response enhanced 

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: