ceftriaxone sodium: clinical use

Prescribing considerations

• Obtain appropriate cultures and consider susceptibility, infection site, illness severity and local resistance patterns.
• Consider additional antibacterial coverage when likely pathogens fall outside ceftriaxone’s spectrum or infection is polymicrobial.
• Review beta-lactam allergy carefully.
• Account for sodium content where sodium restriction is required.
• Use close surveillance when severe renal and hepatic impairment coexist or neurological toxicity is suspected.

Contraindications and cautions

• Hypersensitivity to ceftriaxone or another cephalosporin.
• Previous severe hypersensitivity to another beta-lactam antibacterial.
• Premature neonates until a postmenstrual age of 41 weeks.
• Full-term neonates up to 28 days old with hyperbilirubinaemia, jaundice, hypoalbuminaemia or acidosis.
• Neonates requiring, or expected to require, intravenous calcium-containing treatment or infusions.
• Intravenous administration of ceftriaxone prepared with lidocaine; lidocaine contraindications also apply to intramuscular preparation.

Monitoring

• Clinical and microbiological response, including superinfection.
• Full blood count during prolonged treatment.
• Renal and hepatic function where clinically indicated.
• INR with vitamin K antagonist anticoagulants.
• Persistent diarrhoea, anaemia, biliary or urinary symptoms, and neurological change.
• Use enzymatic urine-glucose testing where required; ceftriaxone can interfere with Coombs, galactosaemia and some glucose tests.

Clinical pharmacology

A highly protein-bound third-generation cephalosporin that inhibits bacterial cell-wall synthesis. It distributes into many tissues and fluids, including inflamed meninges, and is eliminated unchanged through urine and bile.

Formulation and product differences

• White or almost-white sterile powder in a vial for intravenous injection, intravenous infusion or intramuscular injection.
• Contains ceftriaxone sodium without additional excipients and contributes sodium.
• Use compatible calcium-free diluents. Lidocaine is restricted to intramuscular preparation.
• Prepared solutions may range from pale yellow to amber; reject solutions with visible particles or unexpected changes.

Injection

Route: Parenteral

Strengths: 250 mg, 1 g, 2 g