Ceftriaxone Sodium

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Therapeutic Class
3rd Generation Cephalosporin Antibiotic
Clinical Teaching
Advise patient to report severe diarrhea and consult healthcare professional prior to taking anti-diarrhea medicine. Other superinfection signs/symptoms should be reported as well.
Dosing - Adult
Acute otitis media: 1 to 2 g IV/IM every 24 hr or in divided doses twice a day; maximum 4 g/day
Bacterial endocarditis; Prophylaxis: (high-risk patients; dental, respiratory, or infected skin/skin structure or musculoskeletal tissue procedures) 1 g IV or IM 30 to 60 minutes prior to procedure.
Bacterial musculoskeletal infection: 1 to 2 g IV/IM every 24 hr or in divided doses twice a day; maximum 4 g/day
Chancroid: 250 mg IM as a single dose
Epididymitis: 250 mg IM as a single dose plus doxycycline 100 mg ORALLY twice a day for 10 days
Gonorrhea: uncomplicated, 125 mg to 250 mg IM as a single dose
Gonorrhea: conjunctivitis, 1 g IM as a single dose
Gonorrhea: disseminated, 1 g IV/IM every 24 hr for 24-48 hr after improvement begins then switch to appropriate oral therapy to complete at least 1 week of therapy
Gonorrhea: meningitis and endocarditis, 1 to 2 g IV every 12 hr, for 10-14 days (meningitis) or at least 4 weeks (endocarditis)
Infection of skin AND/OR subcutaneous tissue: 1 to 2 g IV/IM every 24 hr or in divided doses twice a day; maximum 4 g/day
Infectious disease of abdomen: 1 to 2 g IV/IM every 24 hr or in divided doses twice a day; maximum 4 g/day
Infective proctitis: 125 mg IM as a single dose plus doxycycline 100 mg ORALLY twice a day for 7 days
Lower respiratory tract infection: 1 to 2 g IV/IM every 24 hr or in divided doses twice a day; maximum 4 g/day
Lyme disease: 2 g IV once daily for 14 days (range, 10 to 28 days) for early Lyme disease with acute neurological disease manifested by meningitis or radiculopathy, or patients with seventh-cranial-nerve palsy with CNS involvement; for 14 to 21 days for the initial treatment of hospitalized patients with Lyme carditis; for 14 to 28 days for Lyme arthritis with neurological involvement, including those refractory to oral therapy, or late neurologic Lyme disease
Meningitis: 4 g/day IV/IM divided every 12-24 hr; maximum 4 g/day
Pelvic inflammatory disease: 1 to 2 g IV/IM every 24 hr or in divided doses twice a day; maximum 4 g/day
Pelvic inflammatory disease: 250 mg IM as a single dose plus doxycycline 100 mg ORALLY twice daily for 14 days, with or without metronidazole 500 mg ORALLY twice daily for 14 days
Postoperative infection; Prophylaxis: 1 g IV 0.5 to 2 hr prior to surgery
Septicemia: 1 to 2 g IV every 24 hr or in divided doses twice a day; maximum 4 g/day
Sexually transmitted infectious disease; Prophylaxis - Victim of sexual aggression: 125 mg IM as a single dose plus metronidazole 2 g ORALLY as a single dose plus either azithromycin 1 g ORALLY as a single dose or doxycycline 100 mg ORALLY twice a day for 7 days
Urinary tract infectious disease: 1 to 2 g IV/IM every 24 hr or in divided doses twice a day; maximum 4 g/day
Dosing - Dose Adjustment
renal impairment: no dose adjustment needed
hepatic impairment: no dose adjustment needed
combined renal and hepatic impairment: doses should not exceed 2 g/day

Dosing - Pediatric
Acute otitis media: 50 mg/kg IM as a single dose; maximum 1 g/dose
Bacterial endocarditis; Prophylaxis: (high-risk patients; dental, respiratory, or infected skin/skin structure or musculoskeletal tissue procedures) 50 mg/kg IV or IM 30 to 60 minutes prior to procedure
Bacterial musculoskeletal infection: 50 to 75 mg/kg/day IV/IM in divided doses every 12 hr; maximum 2 g/day
Gonorrhea: uncomplicated (45 kg or less), 125 mg IM as a single dose
Gonorrhea: concomitant bacteremia or arthritis (45 kg or less), 50 mg/kg IM or IV in a single daily dose for 7 days; max 1 g/dose
Gonorrhea: concomitant bacteremia or arthritis (greater than 45 kg), 50 mg/kg IM or IV in a single daily dose for 7 days
Gonorrhea: disseminated and scalp abscesses (newborns), 25 to 50 mg/kg IV/IM once daily for 7 days; treat 10-14 days for meningitis
Gonorrhea: ophthalmia neonatorum, 25 to 50 mg/kg IV/IM as a single dose; max 125 mg dose
Gonorrhea: prophylaxis for newborn (maternal gonococcal infection), 25 to 50 mg/kg IV/IM as a single dose; max 125 mg dose
Infection of skin AND/OR subcutaneous tissue: 50 to 75 mg/kg/day IV/IM once daily or in divided doses every 12 hr; maximum 2 g/day
Infectious disease of abdomen: 50 to 75 mg/kg/day IV/IM in divided doses every 12 hr; maximum 2 g/day
Lower respiratory tract infection: 50 to 75 mg/kg/day IV/IM in divided doses every 12 hr; maximum 2 g/day
Lyme disease: 50 to 75 mg/kg/day in a single daily IV dose for 14 days (range, 10 to 28 days) for early Lyme disease for acute neurological disease manifested by meningitis or radiculopathy, or patients with seventh-cranial-nerve palsy with CNS involvement; for 14 to 21 days for the initial treatment of hospitalized patients with Lyme carditis; for 14 to 28 days for Lyme arthritis with neurological involvement, including those refractory to oral therapy, or late neurologic Lyme disease; maximum daily dose, 2 g
Meningitis: 80 to 100 mg/kg/day IV/IM divided every 12-24 hr; maximum 4 g/day
Septicemia: 50 to 75 mg/kg/day IV in divided doses every 12 hr; maximum 2 g/day
Urinary tract infectious disease: 50 to 75 mg/kg/day IV/IM in divided doses every 12 hr; maximum 2 g/day
Warnings - Contraindications
  • concurrent administration of calcium-containing IV solutions, including continuous calcium-containing infusions such as parenteral nutrition, in neonates (aged 28 days or less); risk of fatal salt precipitation in lungs and kidneys
  • hypersensitivity to cephalosporins
  • neonates, hyperbilirubinemic; increased risk of bilirubin encephalopathy (kernicterus), especially in premature neonates

Warnings - Precautions

  • administration of calcium-containing solutions, including continuous calcium-containing infusions such as parenteral nutrition, within 48 hours of ceftriaxone use; has caused fatal salt precipitation in lungs and kidneys of neonates
  • allergy, history (particularly allergy to any drug); increased risk of acute hypersensitivity reaction
  • concurrent calcium-containing solutions, including continuous calcium-containing infusions such as parenteral nutrition, even via different infusion lines, must not be administered within 48 hours
  • gastrointestinal disease, history of; particularly colitis
  • hepatic dysfunction with significant renal disease; increased risk of drug toxicity
  • hypersensitivity to penicillins
  • malnutrition; increased risk of altered prothrombin time due to low vitamin K stores
    biliary stasis and biliary sludge risk factors (preceding major therapy, severe illness, total parenteral nutrition); increased risk of pancreatitis, possibly secondary to biliary obstruction
  • prolonged treatment; may result in overgrowth of nonsusceptible organisms (superinfection)
  • renal failure; increased risk of drug toxicity
  • sonographic abnormalities in gallbladder; ceftriaxone-calcium salt precipitate may be misinterpreted as gallstones
  • vitamin K synthesis, impaired or low vitamin K stores; risk of prothrombin time alteration (rare)

Adverse Effects - Serious
Dermatologic: Erythema multiforme, Stevens-Johnson syndrome, Toxic epidermal necrolysis
Hematologic: Hemolysis, Immune-mediated (rare)
Hepatic: Disorder of gallbladder, Reversible
Immunologic: Immune hypersensitivity reaction (2.7% to 3.3% )
Neurologic: Kernicterus of newborn
Renal: Kidney finding
Respiratory: Lung finding
Mechanism of Action
Ceftriaxone sodium is a semisynthetic, broad-spectrum cephalosporin antibiotic. Its bactericidal activity results from inhibition of cell-wall synthesis and it is highly stable in the presence of penicillinases and cephalosporinases of gram-negative and gram-positive bacteria .
Mechanism of Action - Pharmacokinetics
5.8 h to 8.7 h
Fecal via bile: remaining amount after renal excretion as inactive compounds
Intramuscular: time to peak concentration, 2 h to 3 h
Vd: 5.78 L to 13.5 L
Pediatric patients with bacterial meningitis, Vd: 373 mL/k to 338 mL/kg
Pediatric patients with bacterial meningitis: 4.3 h to 4.6 h
Renal: 33% to 67% unchanged
Dialysis: no (hemodialysis); no (peritoneal dialysis)
Patients with otitis media: 25 h (middle ear fluid)
Protein binding: 85% (300 mcg/mL) to 95% (less than 25 mcg/mL), reversibly bound

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