Difference between revisions of "Ceftriaxone"

(Pediatric Dosing)
 
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==General==
 
==General==
*Type: 3rd generation [[cephalosporins]]
+
*Type: {{#set:cephalosporin generation =3rd}} 3rd generation [[Antibiotic class::Cephalosporin]]
*Dosage Forms: IM, IV
+
*Dosage Forms: injectable solution, powder for injection
 +
*Dosage Strengths: injectable solution: 1g/50mL, 2g/50mL; powder for injection: 250mg, 500mg, 1g, 2g, 10g, 100g
 +
*Routes of Administration: IV, IM
 
*Common Trade Names: Rocephin
 
*Common Trade Names: Rocephin
  
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==Pediatric Dosing==
 
==Pediatric Dosing==
 
===General (<7 Days Old)===
 
===General (<7 Days Old)===
*50 mg/kg IM/IV q24h
+
*50mg/kg IM/IV q24h
*First ED Dose: 50 mg/kg IM/IV x 1
+
*First Dose: 50mg/kg IM/IV x 1
  
 
===General (7 Days - 1 Month)===
 
===General (7 Days - 1 Month)===
 
*<2000g
 
*<2000g
**50 mg/kg IM/IV q24h
+
**50mg/kg IM/IV q24h
**First ED Dose: 50 mg/kg IM/IV x 1
+
**First Dose: 50mg/kg IM/IV x 1
 
*>2000g
 
*>2000g
**50-75 mg/kg IM/IV q24h
+
**50-75mg/kg IM/IV q24h
**First ED Dose: 50-75 mg/kg IM/IV x 1
+
**First Dose: 50-75mg/kg IM/IV x 1
  
 
===General (>1 Month - Adult)===
 
===General (>1 Month - Adult)===
*50-100 mg/kg IM/IV divided q12-24h
+
*50-100mg/kg IM/IV divided q12-24h
*First ED Dose: 50-100 mg/kg IM/IV x 1
+
*First Dose: 50-100mg/kg IM/IV x 1
 
*Max: 4g/24h
 
*Max: 4g/24h
 +
 +
===Acute [[Otitis Media]] (2 Months - 12 Years)===
 +
*50mg/kg IM/IV x 1
 +
*Give 50mg/kg IM/IV q24h x 3 days for recurrent infection
 +
*Max 1g/dose
 +
 +
===Bacterial [[Meningitis]]===
 +
*80-100mg/kg IV divided q12-24h x 7-21 days
 +
*First Dose: 100mg/kg IV x 1
 +
*Max: 4g/24h
 +
 +
===[[Pneumonia]], Community-Acquired (>3 Months)===
 +
*50-100mg/kg/day IM/IV divided q12-24h x 10 days
 +
*First Dose:
 +
*Max: 2g/day
 +
*Info: May switch to PO when possible to complete course
 +
 +
==Special Populations==
 +
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: B
 +
*Lactation: Probably safe
 +
*Renal Dosing
 +
**Adult
 +
***Renal failure: No initial adjustment, monitor serum levels
 +
***Hemodialysis: give dose after dialysis, no supplement
 +
***Peritoneal Dialysis: 750mg q12h
 +
**Pediatric
 +
***CrCl <10: give q24h
 +
***Hemodialysis: 50mg/kg q24, no supplement
 +
***Peritoneal Dialysis: 50mg/kg q24, no supplement
 +
*Hepatic Dosing
 +
**Adult
 +
***Hepatic and renal disease: max 2g/day, unless closely monitoring serum levels
 +
**Pediatric
 +
***May requrire dose adjustment but specific dosing not defined
  
 
==Contraindications==
 
==Contraindications==
*Allergy to class/drug
+
*Allergy to class/drug (see also [[Cephalosporin Cross-reactivity]])
 +
*Patients <1 month old
 +
**Hyperbillirubinemia
 +
**IV calcium containing product
 +
**If a 3rd generation cephalosporin is required, consider using Cefotaxime instead
  
 
==Adverse Reactions==
 
==Adverse Reactions==
 +
===Serious===
 +
*[[Anaphylaxis]]
 +
*Broncospasm
 +
*[[Stevens-Johnson Syndrome]]
 +
*[[Toxic Epidermal Necrolysis]]
 +
*Erythema multiforme
 +
*Serum sickness
 +
*Pneumonitis
 +
*Neutropenia
 +
*Leukopenia
 +
*Hemolytic anemia
 +
*[[Thrombocytopenia]]
 +
*Hypoprothrombinemia
 +
*Agranulocytosis
 +
*Superinfection
 +
*[[Clostridium difficile]]
 +
*Colitis
 +
*Billiary/gallbladder sludge
 +
*[[Jaundice]]
 +
*[[Pancreatitis]]
 +
*[[Seizures]]
 +
*[[Nephrolithiasis]]
 +
*Lung/kidney calcium precipitate (neonates)
 +
 +
===Common===
 +
*Local infection site reaction
 +
*Eosinophilia
 +
*Thrombocytosis
 +
*Transaminitis
 +
*[[Diarrhea]]
 +
*Leukopenia
  
 
==Pharmacology==
 
==Pharmacology==
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*Mechanism of Action: bactericidal; inhibits cell wall synthesis
 
*Mechanism of Action: bactericidal; inhibits cell wall synthesis
  
==Pregnancy/Lactation==
+
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
*Pregnancy: B
+
{| class="wikitable"
*Lactation: Probably safe
+
| align="center" style="background:#f0f0f0;"|'''Group'''
 +
| align="center" style="background:#f0f0f0;"|'''Organism'''
 +
| align="center" style="background:#f0f0f0;"|'''Sensitivity'''
 +
|-
 +
| Gram Positive||[[Strep. Group A, B, C, G]]||'''S'''
 +
|-
 +
| ||[[Strep. Pneumoniae]]||'''S'''
 +
|-
 +
| ||[[Viridans strep]]||'''S'''
 +
|-
 +
| ||Strep. anginosus gp||X1
 +
|-
 +
| ||[[Enterococcus faecalis]]||R
 +
|-
 +
| ||[[Enterococcus faecium]]||X1
 +
|-
 +
| ||[[MSSA]]||'''S'''
 +
|-
 +
| ||[[MRSA]]||R
 +
|-
 +
| ||[[CA-MRSA]]||R
 +
|-
 +
| ||[[Staph. Epidermidis]]||I
 +
|-
 +
| ||[[C. jeikeium]]||R
 +
|-
 +
| ||[[L. monocytogenes]]||R
 +
|-
 +
| Gram Negatives||[[N. gonorrhoeae]]||I
 +
|-
 +
| ||[[N. meningitidis]]||'''S'''
 +
|-
 +
| ||[[Moraxella catarrhalis]]||'''S'''
 +
|-
 +
| ||[[H. influenzae]]||'''S'''
 +
|-
 +
| ||[[E. coli]]||'''S'''
 +
|-
 +
| ||[[Klebsiella]] sp||'''S'''
 +
|-
 +
| ||E. coli/Klebsiella ESBL+||R
 +
|-
 +
| ||E coli/Klebsiella KPC+||R
 +
|-
 +
| ||[[Enterobacter]] sp, AmpC neg||'''S'''
 +
|-
 +
| ||[[Enterobacter]] sp, AmpC pos||R
 +
|-
 +
| ||[[Serratia]] sp||'''S'''
 +
|-
 +
| ||Serratia marcescens||X1
 +
|-
 +
| ||[[Salmonella]] sp||'''S'''
 +
|-
 +
| ||[[Shigella]] sp||'''S'''
 +
|-
 +
| ||[[Proteus mirabilis]]||'''S'''
 +
|-
 +
| ||[[Proteus vulgaris]]||'''S'''
 +
|-
 +
| ||[[Providencia sp.]]||'''S'''
 +
|-
 +
| ||[[Morganella sp.]]||'''S'''
 +
|-
 +
| ||[[Citrobacter freundii]]||'''S'''
 +
|-
 +
| ||[[Citrobacter diversus]]||'''S'''
 +
|-
 +
| ||[[Citrobacter sp.]]||'''S'''
 +
|-
 +
| ||[[Aeromonas sp]]||'''S'''
 +
|-
 +
| ||[[Acinetobacter sp.]]||R
 +
|-
 +
| ||[[Pseudomonas aeruginosa]]||R
 +
|-
 +
| ||[[Burkholderia cepacia]]||I
 +
|-
 +
| ||[[Stenotrophomonas maltophilia]]||R
 +
|-
 +
| ||[[Yersinia enterocolitica]]||'''S'''
 +
|-
 +
| ||[[Francisella tularensis]]||X1
 +
|-
 +
| ||[[Brucella sp.]]||X1
 +
|-
 +
| ||[[Legionella sp.]]||R
 +
|-
 +
| ||[[Pasteurella multocida]]||'''S'''
 +
|-
 +
| ||[[Haemophilus ducreyi]]||'''S'''
 +
|-
 +
| ||[[Vibrio vulnificus]]||X1
 +
|-
 +
| Misc||[[Chlamydophila sp]]||X1
 +
|-
 +
| ||[[Mycoplasm pneumoniae]]||X1
 +
|-
 +
| ||[[Rickettsia sp]]||X1
 +
|-
 +
| ||[[Mycobacterium avium]]||X1
 +
|-
 +
| Anaerobes||[[Actinomyces]]||'''S'''
 +
|-
 +
| ||[[Bacteroides fragilis]]||R
 +
|-
 +
| ||[[Prevotella melaninogenica]]||I
 +
|-
 +
| ||[[Clostridium difficile]]||X1
 +
|-
 +
| ||[[Clostridium (not difficile)]]||'''S'''
 +
|-
 +
| ||[[Fusobacterium necrophorum]]||X1
 +
|-
 +
| ||[[Peptostreptococcus sp.]]||'''S'''
 +
|}
 +
 
 +
===Key===
 +
{{Template:Antibacterial Spectra Key}}
  
 
==See Also==
 
==See Also==
 
*[[Antibiotics (Main)]]
 
*[[Antibiotics (Main)]]
  
==Source==
+
==References==
 +
<references/>
  
[[Category:Drugs]]
+
[[Category:Pharmacology]] [[Category:ID]]

Latest revision as of 22:03, 19 September 2019

General

  • Type: 3rd generation Cephalosporin
  • Dosage Forms: injectable solution, powder for injection
  • Dosage Strengths: injectable solution: 1g/50mL, 2g/50mL; powder for injection: 250mg, 500mg, 1g, 2g, 10g, 100g
  • Routes of Administration: IV, IM
  • Common Trade Names: Rocephin

Adult Dosing

General

  • 1-2g IM/IV q24h
  • First ED Dose: 1g IM/IV x 1
  • Max: 4g/24h

Bacterial Meningitis

  • 4g IV divided q12-24h x 7-21 days
  • First ED Dose: 2g IM/IV x 1

Gonococcal

  • Uncomplicated, initial: 250mg IM x 1
    • Also treat for chlamydia regardless of test results
  • Uncomplicated, recurrent of persistent: 500-1000mg IM x 1
  • Disseminated: 1g IM/IV q24h
    • May switch to cefixime PO after 24-48h if clinical improvement
  • Conjunctivitis: 1g IM x 1
  • Prophylaxis (sexual assault victims)
    • 250mg IM x 1

PID

  • 250mg IM x 1
  • Use with doxycycline +/- metronidazole

Sinusitis, Severe

  • 1-2g IV q12-24h x 7-10 days

Endocarditis

  • 1g IM/IV x 1
    • 30-60 min before procedure

Proctitis, Epididymitis, Chancroid

  • 250mg IM x 1
    • Give with doxycycline

Surgical Prophylaxis

  • 1g IV x 1
    • Give 0.5-2h preop

Typhoid Fever

  • 60mg/kg IV q24h x 2wk
  • Max: 4g/24h

Pediatric Dosing

General (<7 Days Old)

  • 50mg/kg IM/IV q24h
  • First Dose: 50mg/kg IM/IV x 1

General (7 Days - 1 Month)

  • <2000g
    • 50mg/kg IM/IV q24h
    • First Dose: 50mg/kg IM/IV x 1
  • >2000g
    • 50-75mg/kg IM/IV q24h
    • First Dose: 50-75mg/kg IM/IV x 1

General (>1 Month - Adult)

  • 50-100mg/kg IM/IV divided q12-24h
  • First Dose: 50-100mg/kg IM/IV x 1
  • Max: 4g/24h

Acute Otitis Media (2 Months - 12 Years)

  • 50mg/kg IM/IV x 1
  • Give 50mg/kg IM/IV q24h x 3 days for recurrent infection
  • Max 1g/dose

Bacterial Meningitis

  • 80-100mg/kg IV divided q12-24h x 7-21 days
  • First Dose: 100mg/kg IV x 1
  • Max: 4g/24h

Pneumonia, Community-Acquired (>3 Months)

  • 50-100mg/kg/day IM/IV divided q12-24h x 10 days
  • First Dose:
  • Max: 2g/day
  • Info: May switch to PO when possible to complete course

Special Populations

  • Pregnancy Rating: B
  • Lactation: Probably safe
  • Renal Dosing
    • Adult
      • Renal failure: No initial adjustment, monitor serum levels
      • Hemodialysis: give dose after dialysis, no supplement
      • Peritoneal Dialysis: 750mg q12h
    • Pediatric
      • CrCl <10: give q24h
      • Hemodialysis: 50mg/kg q24, no supplement
      • Peritoneal Dialysis: 50mg/kg q24, no supplement
  • Hepatic Dosing
    • Adult
      • Hepatic and renal disease: max 2g/day, unless closely monitoring serum levels
    • Pediatric
      • May requrire dose adjustment but specific dosing not defined

Contraindications

  • Allergy to class/drug (see also Cephalosporin Cross-reactivity)
  • Patients <1 month old
    • Hyperbillirubinemia
    • IV calcium containing product
    • If a 3rd generation cephalosporin is required, consider using Cefotaxime instead

Adverse Reactions

Serious

Common

  • Local infection site reaction
  • Eosinophilia
  • Thrombocytosis
  • Transaminitis
  • Diarrhea
  • Leukopenia

Pharmacology

  • Half-life: 5.8-8.7h, 15h (CrCl 5-15)
  • Metabolism: CYP450
  • Excretion: Primarily urine
  • Mechanism of Action: bactericidal; inhibits cell wall synthesis

Antibiotic Sensitivities[1]

Group Organism Sensitivity
Gram Positive Strep. Group A, B, C, G S
Strep. Pneumoniae S
Viridans strep S
Strep. anginosus gp X1
Enterococcus faecalis R
Enterococcus faecium X1
MSSA S
MRSA R
CA-MRSA R
Staph. Epidermidis I
C. jeikeium R
L. monocytogenes R
Gram Negatives N. gonorrhoeae I
N. meningitidis S
Moraxella catarrhalis S
H. influenzae S
E. coli S
Klebsiella sp S
E. coli/Klebsiella ESBL+ R
E coli/Klebsiella KPC+ R
Enterobacter sp, AmpC neg S
Enterobacter sp, AmpC pos R
Serratia sp S
Serratia marcescens X1
Salmonella sp S
Shigella sp S
Proteus mirabilis S
Proteus vulgaris S
Providencia sp. S
Morganella sp. S
Citrobacter freundii S
Citrobacter diversus S
Citrobacter sp. S
Aeromonas sp S
Acinetobacter sp. R
Pseudomonas aeruginosa R
Burkholderia cepacia I
Stenotrophomonas maltophilia R
Yersinia enterocolitica S
Francisella tularensis X1
Brucella sp. X1
Legionella sp. R
Pasteurella multocida S
Haemophilus ducreyi S
Vibrio vulnificus X1
Misc Chlamydophila sp X1
Mycoplasm pneumoniae X1
Rickettsia sp X1
Mycobacterium avium X1
Anaerobes Actinomyces S
Bacteroides fragilis R
Prevotella melaninogenica I
Clostridium difficile X1
Clostridium (not difficile) S
Fusobacterium necrophorum X1
Peptostreptococcus sp. S

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References

  1. Sanford Guide to Antimicrobial Therapy 2014