Ceftriaxone: Difference between revisions
Line 82: | Line 82: | ||
==Special Populations== | ==Special Populations== | ||
*Pregnancy: B | *[[Drug Ratings in Pregnancy|Pregnancy Rating]]: B | ||
*Lactation: Probably safe | *Lactation: Probably safe | ||
*Renal Dosing | *Renal Dosing |
Revision as of 13:38, 27 March 2014
General
- Type: 3rd generation cephalosporins
- Dosage Forms: IM, IV
- 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)
- 50 mg/kg IM/IV q24h
- First Dose: 50 mg/kg IM/IV x 1
General (7 Days - 1 Month)
- <2000g
- 50 mg/kg IM/IV q24h
- First Dose: 50 mg/kg IM/IV x 1
- >2000g
- 50-75 mg/kg IM/IV q24h
- First Dose: 50-75 mg/kg IM/IV x 1
General (>1 Month - Adult)
- 50-100 mg/kg IM/IV divided q12-24h
- First Dose: 50-100 mg/kg IM/IV x 1
- Max: 4g/24h
Acute Otitis Media (2 Months - 12 Years)
- 50 mg/kg IM/IV x 1
- Give 50 mg/kg IM/IV q24h x 3 days for recurrent infection
- Max 1g/dose
Bacterial Meningitis
- 80-100 mg/kg IV divided q12-24h x 7-21 days
- First Dose: 100mg/kg IV x 1
- Max: 4g/24h
Pneumonia, Community-Acquired (>3 Months)
- 50-100 mg/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: 50 mg/kg q24, no supplement
- Peritoneal Dialysis: 50 mg/kg q24, no supplement
- Adult
- 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
- Adult
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
- 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
- Half-life: 5.8-8.7h, 15h (CrCl 5-15)
- Metabolism: CYP450
- Excretion: Primarily urine
- Mechanism of Action: bactericidal; inhibits cell wall synthesis
See Also
Source
- Epocrates