NAME OF DRUG
ceftriaxone disodium

CLASSIFICATION

Cephalosporin antibiotic
(RESERVED ANTIMICROBIAL DRUG)

ALTERNATE NAMES

ROCEPHIN

 INDICATIONS

• treatment of systemic infections caused by susceptible strains of micro-organisms

RECONSTITUTION AND STABILITY

• powder stable at room temperature, protect from light
• IM - reconstitute 250 mg vial with 0.9 mL sterile water or 1% lidocaine (without epinephrine) to yield a 250 mg/mL solution
• reconstitute 1 g vial with 3.6 mL sterile water or 1% lidocaine (without epinephrine) to yield a 250 mg/mL solution
• reconstitute 2 g vial with 7.2 mL sterile water or 1% lidocaine (without epinephrine) to yield a 250 mg/mL solution
• IV Intermittent - reconstitute 1 g vial with 9.6 mL sterile water for injection to yield a 100 mg/mL solution
• reconstitute 2 g vial with 19.2 mL sterile water for injection to yield a 100 mg/mL solution
• reconstituted solution should not be stored for more than 24 hours in refrigerator

 COMPATIBILITY

• compatible with D5W, NS
• compatible via Y-site with acyclovir, clindamycin, heparin, meperidine, metronidazole, morphine, multivitamins, pantoprazole, potassium chloride

• incompatible with aminoglycosides, calcium chloride, calcium gluconate, TPN

   

ROUTES OF ADMINISTRATION

• IM - deep, not greater than 1 g per injection site
• IV direct - dilute to 10 mL with sterile water for injection, NS, or D5W and administer over 5 minutes
• IV intermittent - dilute dose in 50-100 mL IV solution; administer over 20-30 minutes

 VH & HSC ADMINISTRATION POLICY

E - Direct IV route can be administered by nurses on general nursing units provided that a venous access has been established and according to policies and recommendations stated in this manual

 DOSAGE

Adult: 

• 1-2 g every 24 hours
• Daily dose should not exceed 4 g
• Uncomplicated gonorrhea: 250 mg single dose IM

Children: under 12 years -

• 50-75 mg/kg/day in two divided doses
• Total daily dose should not exceed 2 g 
• Meningitis; 100 mg/kg/day in two divided doses; Total daily dose should not exceed 4 g

 POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION

• pain at IM injection site, not more than 1 gram should be injected at a single injection site
• hypersensitivity allergic reactions
• thrombophlebitis and inflammation

 IMPORTANT IMPLICATIONS

• contraindicated in patients with known hypersensitivity to cephalosporins
• caution in patients with hypersensitivity to penicillins
• concurrent administration of parenteral calcium with ceftriaxone should be avoided due to risk of precipitation; there have been recent reports of fatalities associated with the use of ceftriaxone and calcium in neonates. Cause of death was attributed to precipitation in patients’ lungs and kidneys. However, there is no indication that a similar risk exists in adults receiving this combination.
• hypoprothrombinemia and alterations in prothrombin time may occur rarely
• Vitamin K administration (10 mg weekly) may be necessary if the prothrombin time is prolonged before or during treatment
• sodium content of each gram of ceftriaxone is 83 mg (3.6 mmol)

Rev. May 2008