| CEFTRIAXONE SODIUM
Classifications: antibiotic; third-generation cephalosporin; Therapeutic:antibiotic; cephalosporin
Prototype: Cefotaxime sodium
Pregnancy Category: B
250 mg, 500 mg, 1 g, 2 g injection
Semisynthetic third-generation cephalosporin antibiotic. Preferentially binds to one or more of the penicillin-binding proteins
(PBP) located on cell walls of susceptible organisms. This inhibits third and final stage of bacterial cell wall synthesis,
thus killing the bacterium.
Similar to other third-generation cephalosporins, ceftriaxone is effective against serious gram-negative organisms and
also penetrates the CSF in concentrations useful in treatment of meningitis.
Infections caused by susceptible organisms in lower respiratory tract, skin and skin structures, urinary tract, bones and
joints; also intra-abdominal infections, pelvic inflammatory disease, uncomplicated gonorrhea, meningitis, and surgical
Hypersensitivity to cephalosporins and related antibiotics; viral infections; neonates with hyperbilirubinemia, premature
Coagulopathy, GI disease, colitis; renal disease, renal impairment; pregnancy (category B).
Route & Dosage
|Moderate to Severe Infections
Adult: IV/IM 12 g q1224h (max: 4 g/d)
Child: IV/IM 5075 mg/kg/d in 2 divided doses (max: 2 g/d)
Adult: IV/IM 2 g q12h
Child: IV/IM 100 mg/kg/d in 2 divided doses (max: 4 g/d)
Adult: IV/IM 1 g 30120 min before surgery
Adult: IM 250 mg as single dose
Child: IM 125 mg as single dose
- Reconstitute the 1 g or 2 g vial by adding 2.1 mL or 4.2 mL, respectively, of sterile water for injection. Yields 350 mg/mL.
See manufacturer's directions for other dilutions.
- Give deep IM into a large muscle.
- IV administration to infants and children: Verify correct IV concentration and rate of infusion with physician.
PREPARE: Intermittent: Reconstitute each 250 mg with 2.4 mL of sterile water, D5W, NS, or D5/NS to yield 100 mg/mL. Further dilute with 50100
mL of the selected IV solution.
ADMINISTER: Intermittent: Give over 30 min.
INCOMPATIBILITIES Solution/additive: aminoglycosides, aminophylline, clindamycin, lidocaine, linezolid, metronidazole, theophylline, calcium containing products. Y-site: aminoglycosides, amphotericin B cholesteryl complex, amsacrine, azithromycin, calcium containing products, filgrastim, fluconazole, labetalol, pentamidine, vancomycin, vinorelbine.
- Protect sterile powder from light. Store at 15°25° C (59°77° F). Reconstituted solutions:
diluent, concentration of solutions are determinants of stability. See manufacturer's instructions for storage.
Adverse Effects (≥1%) Body as a Whole:
Pruritus, fever, chills, pain, induration at IM injection site; phlebitis (IV
site). GI: Diarrhea,
abdominal cramps, pseudomembranous colitis,
biliary sludge. Urogenital:
Genital pruritus; moniliasis.
Diagnostic Test Interference
Causes prolonged PT/INR during therapy.
elimination of ceftriaxone; alcohol
reaction; effect of warfarin
may be increased.
1.54 h after IM; immediately after IV
Widely distributed in body tissues and fluids; good CNS
penetration; crosses placenta. Metabolism:
Not metabolized. Elimination:
3365% unchanged in urine; also in bile and breast milk. Half-Life:
Assessment & Drug Effects
- Determine history of hypersensitivity reactions to cephalosporins and penicillins and history of other allergies, particularly
to drugs, before therapy is initiated.
- Lab tests: Perform culture and sensitivity tests before initiation of therapy and periodically during therapy. Dosage may
be started pending test results. Periodic coagulation studies (PT and INR) should be done.
- Inspect injection sites for induration and inflammation. Rotate sites. Note IV injection sites for signs of phlebitis (redness,
- Monitor for manifestations of hypersensitivity (see Appendix F). Report their appearance promptly and discontinue drug.
- Watch for and report signs: petechiae, ecchymotic areas, epistaxis, or any unexplained bleeding. Ceftriaxone appears to alter
vitamin Kproducing gut bacteria; therefore, hypoprothrombinemic bleeding may occur.
- Check for fever if diarrhea occurs: Report both promptly. The incidence of antibiotic-produced pseudomembranous colitis (see
Appendix F) is higher than with most cephalosporins. Most vulnerable patients: chronically ill or debilitated older adult
patients undergoing abdominal surgery.
Patient & Family Education
- Report any signs of bleeding.
- Report loose stools or diarrhea promptly.