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Ceftriaxone

Powder for injection: 250 mg; 1 g (as sodium salt) in vial.

Ceftriaxone is a representative third generation cefalosporin antibiotic. Various medicines can serve as alternatives.

Ceftriaxone is a complementary list medicine for use only when there is significant resistance to other antibacterial medicines on the WHO Model List.

Uses: serious infections due to sensitive bacteria, including septicaemia,pneumonia, and meningitis; osteomyelitis, septic arthritis; Haemophilus influenzae epiglottis; surgical prophylaxis; prophylaxis of meningococcal meningitis; shigellosis, invasive salmonellosis; endocarditis; gonococcal conjunctivitis; gonorrhoea; pelvic inflammatory disease; Lyme disease.

Contraindications: hypersensitivity to cefalosporins; porphyria; neonates with jaundice, hypoalbuminaemia, acidosis or impaired bilirubin binding.

Precautions: sensitivity to Beta Lactam antibacterials (avoid if history of immediate hypersensitivity reactions; see introductory note above); severe renal impairment (Appendix 4); hepatic impairment if accompanied by renal impairment (Appendix 5); premature neonates (may displace bilirubin from serum albumin); treatment longer than 14 days, renal failure, dehydration,or concomitant total parenteral nutrition (risk of ceftriaxone precipitation in gallbladder); pregnancy and breastfeeding (but appropriate to use, see Appendices 2 and 3); false positive urinary glucose (if tested for reducing substances) and false positive Coombs’ test; interactions: Appendix 1.

Dose:

Infections due to susceptible organisms, by deep intramuscular injection, by intravenous injection (over at least 2–4 minutes), or by intravenous infusion, ADULT,1 g daily; up to 2–4 g daily in severe infections; INFANT and CHILD under 50 kg, 20–50 mg/kg daily should be given, up to 80 mg/kg daily in severe infections (doses of 50 mg/kg and over by intravenous infusion only); by intravenous infusion (over 60 minutes), NEONATE, 20–50 mg/kg daily (maximum, 50 mg/kg daily).Uncomplicated gonorrhoea and gonococcal conjunctivitis, by deep intramuscular

injection, ADULT, 125 mg as a single dose (also used with doxycycline and metronidazole to treat pelvic inflammatory disease).Neonatal gonococcal conjunctivitis, by intramuscular injection, NEONATE,50 mg/kg as a single dose (maximum, 125 mg).6. Anti-infective medicines 110 WHO Model Formulary 2008 Disseminated gonococcal infection, by deep intramuscular injection or by intravenous injection, ADULT, 1 g daily for 7 days.Surgical prophylaxis, by deep intramuscular injection or by intravenous injection (over at least 2–4 minutes), ADULT, 1 g at induction.Colorectal surgery (with an antibacterial active against anaerobes), by deep intramuscular injection, by intravenous injection (over at least 2–4 minutes), or by  intravenous infusion, ADULT, 2 g as a single dose.RECONSTITUTION AND ADMINISTRATION. According to manufacturer’s directions. Intramuscular doses over 1 g should be divided between more than one site. Administer by intravenous infusion over 60 minutes in neonates (see also Contraindications).

Adverse effects: diarrhoea, nausea and vomiting, abdominal discomfort,headache; rarely antibiotic-associated colitis (particularly with higher doses);allergic reactions including rash, pruritus, urticaria, serum sickness-like reactions, fever and arthralgia, and anaphylaxis; erythema multiforme and toxic epidermal necrolysis reported; transient hepatitis, cholestatic jaundice;eosinophilia and blood disorders (including thrombocytopenia, leukopenia,

agranulocytosis, aplastic anaemia, and haemolytic anaemia); reversible interstitial nephritis, hyperactivity, nervousness, sleep disturbances, hallucinations, confusion, hypertonia and dizziness; calcium ceftriaxone precipitates in the urine (particularly in the very young, the dehydrated, or in those who are immobilized) or in the gallbladder (consider discontinuation if symptomatic); rarely prolongation of prothrombin time and pancreatitis.

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