Spectrum: Local Antimicrobial Stewardship, for Prisma Health Children’s Hospital-Midlands

Ceftriaxone

C. diff Risk

High

Oral Bioavailability

NA

Approximate Cost

$

Spectrum Of Activity

General Spectrum of Activity

Spectrum Of Activity

General Spectrum of Activity

Antibiogram Data

Dosing

Pediatric

Neonatal

General Information

Acceptable Uses

Acceptable Uses

Treatment

  • Sepsis

  • Meningitis

  • Pneumonia

  • Acute otitis media

  • Rhinosinusitis

  • Skin and soft tissue infections

  • Bone and joint infections

  • Intra-abdominal infections

  • Urinary tract infections

  • Endocarditis

  • Salmonellosis and shigellosis

  • Uncomplicated gonococcal infection or pelvic inflammatory disease

Prophylaxis

  • Surgical prophylaxis

  • Bacterial endocarditis in high risk patients undergoing dental treatment

  • Peritonitis in PD patients undergoing dental treatment

Unacceptable Uses

Unacceptable Uses

  • Enterococci

  • B. fragilis

  • Pseudomonas (and other more resistant gram negatives)

  • ESBL or AmpC producing Enterobacteriaceae

  • Listeria

  • MRSA

Drug Monitoring

Drug Monitoring

CBC with differential, platelet count, PT, renal and hepatic function tests periodically. If using in patient < 30 days old, monitor bilirubin at baseline to ensure < 5 mg/dL.

First Line Indications

First Line Indications

  • Intra-abdominal infections

  • Meningitis

  • Urinary Tract Infections

Adverse Effects

Adverse Effects

  • Allergy/rash (immediate or delayed)

  • Cytopenias, eosinophilia

  • Pseudocholelithiasis

Major Interactions

Major Interactions
  • Calcium containing IV solutions: May enhance the adverse/toxic effect of CefTRIAXone. Ceftriaxone binds to calcium forming an insoluble precipitate. Use of ceftriaxone is contraindicated in neonates who require treatment with IV calcium-containing solutions.

Additional Information

Additional Information

IM ceftriaxone may be given with 1% lidocaine to minimize pain at injection site

Pharmacology

Pharmacology

Antimicrobial class: Parenteral Cephalosporin - 3rd Generation

Pregnancy category: B

Average serum half life:

  • Neonates: 1-4 days of life: 16 hours; 9-30 days of life: 9 hours

  • Pediatrics: 6 hours

  • adults: 8 hours

Biliary penetration: Good (40-50% unchanged excreted in bile)

CSF penetration: Good (8-16%). Higher concentrations when meninges are inflamed.

Lung penetration: Good

Urine penetration: Good (33-67% unchanged)

Route of Elimination: Unchanged in the urine (33-67%) by glomerular filtration and in feces via bile