Hydrated disodium ceftriaxone: clinical use

Prescribing considerations

• Confirm that likely or identified pathogens fall within ceftriaxone's spectrum; polymicrobial infection may require another antibacterial.
• Establish the nature and severity of previous cephalosporin, penicillin or other beta-lactam reactions.
• Review renal and hepatic function, biliary or renal stone history, sodium restriction, intravenous calcium exposure and parenteral nutrition.
• Consider ceftriaxone-associated colitis when diarrhoea develops during or after treatment.
• Account for interference with Coombs testing, galactosaemia testing, non-enzymatic urine glucose tests and some blood-glucose monitoring systems.

Contraindications and cautions

• Hypersensitivity to ceftriaxone or another cephalosporin.
• Previous severe immediate hypersensitivity to another beta-lactam antibacterial.
• Premature neonates up to a postmenstrual age of 41 weeks.
• Full-term neonates with jaundice, hyperbilirubinaemia, hypoalbuminaemia or acidosis.
• Neonates requiring or expected to require intravenous calcium-containing treatment.
• Relevant lidocaine contraindication when lidocaine is used for intramuscular preparation; lidocaine-containing ceftriaxone must never be given intravenously.

Monitoring

• Clinical response and microbiology or susceptibility results where available.
• Regular full blood count during prolonged treatment.
• Renal and hepatic function when clinically indicated, with close observation where both are severely impaired.
• INR with a vitamin K antagonist.
• Neurological status in patients at increased risk of encephalopathy.
• Symptoms suggesting colitis, haemolysis, biliary precipitation, pancreatitis or renal precipitation.

Clinical pharmacology

A highly protein-bound, bactericidal third-generation cephalosporin eliminated unchanged through urine and bile. It penetrates many tissues and inflamed meninges; activity depends on how long unbound concentrations remain above the organism's minimum inhibitory concentration.

Formulation and product differences

• The product is a powder requiring reconstitution for intravenous or intramuscular administration.
• It contains ceftriaxone as the sodium salt and no other listed excipients, but contributes sodium.
• Intramuscular preparation may use lidocaine; that solution must never be given intravenously.
• Intravenous preparation requires compatible calcium-free diluents. Reconstituted solution should be clear, particle-free and used according to product-specific storage requirements.

Injection

Route: Parenteral

Strengths: 1 g, 2 g