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1 Half-life: 6– 9 hr.
TIME/ACTION PROFILE PDF Page #1
cefTRIAXone (sef-try-ax-one) ROUTE ONSET PEAK DURATION
Rocephin IM rapid 1–2 hr 12–24 hr
Classification IV rapid end of infusion 12–24 hr
Therapeutic: anti-infectives
Pharmacologic: third-generation cephalosporins Contraindications/Precautions
Pregnancy Category B Contraindicated in: Hypersensitivity to cephalosporins; Serious hypersensitivity
to penicillins; Pedi: Neonates ⱕ28 days (use in hyperbilirubinemic neonates may
lead to kernicterus); Pedi: Neonates ⱕ28 days requiring calcium-containing IV solu-
Indications tions (qrisk of precipitation formation).
Treatment of: Skin and skin structure infections, Bone and joint infections, Compli- Use Cautiously in: Combined severe hepatic and renal impairment (dose reduc-
cated and uncomplicated urinary tract infections, Uncomplicated gynecological in- tion/qdosing interval recommended); History of GI disease, especially colitis; OB,
fections including gonorrhea, Lower respiratory tract infections, Intra-abdominal in- Lactation: Pregnancy and lactation.
fections, Septicemia, Meningitis, Otitis media. Perioperative prophylaxis.
Adverse Reactions/Side Effects
Action CNS: SEIZURES (high doses). GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, cholelithia-
Binds to the bacterial cell wall membrane, causing cell death. Therapeutic Ef- sis, gallbladder sludging. Derm: rashes, urticaria. Hemat: bleeding, eosinophilia,
fects: Bactericidal action against susceptible bacteria. Spectrum: Similar to that of hemolytic anemia, leukopenia, thrombocytosis. Local: pain at IM site, phlebitis at IV
second-generation cephalosporins, but activity against staphylococci is less, while site. Misc: allergic reactions including ANAPHYLAXIS, superinfection.
activity against gram-negative pathogens is greater, even for organisms resistant to
first- and second-generation agents. Notable is increased action against: Acinetobac- Interactions
ter, Enterobacter, Haemophilus influenzae (including ␤-lactamase-producing Drug-Drug: Should not be administered concomitantly with any calcium-contain-
strains), Haemophilus parainfluenzae, Escherichia coli, Klebsiella pneumoniae, ing solutions.
Morganella morganii, Neisseria, Proteus, Providencia, Serratia, Moraxella catar- Route/Dosage
rhalis. Has some activity against anaerobes, includingBacteroides fragilis. Not active IM, IV (Adults): Most infections— 1– 2 g every 12– 24 hr Gonorrhea— 250 mg
against methicillin-resistant staphylococci or enterococci. IM (single dose). Meningitis— 2 g every 12 hr. Perioperative prophylaxis— 1 g
0.5– 2 hr before surgery (single dose).
Pharmacokinetics IM, IV (Children): Most infections— 50– 75 mg/kg/day (not to exceed 2 g/day)
Absorption: Well absorbed following IM administration; IV administration results divided every 12– 24 hr. Meningitis— 100 mg/kg/day (not to exceed 4 g/day) di-
in complete bioavailability. vided every 12– 24 hr or Uncomplicated gonorrhea— 125 mg IM (single dose).
Distribution: Widely distributed. CSF penetration better than with first- and sec- Acute otitis media— 50 mg/kg (not to exceed 1 g) IM single dose.
ond-generation agents. Crosses the placenta; enters breast milk in low concentra-
tions. NURSING IMPLICATIONS
Protein Binding: ⱖ90%. Assessment
Metabolism and Excretion: 33– 67% excreted in urine as unchanged drug; re- ● Assess for infection (vital signs; appearance of wound, sputum, urine, and stool;
mainder excreted in feces. WBC) at beginning of and throughout therapy.
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
Name /bks_53161_deglins_md_disk/ceftriaxone 02/19/2014 09:43AM
2 ● If aminoglycosides are administered concurrently, administer in separate sites, if
● Before initiating therapy, obtain a history to determine previous use of and reac-
tions to penicillins or cephalosporins. Persons with a negative history of penicillin
sensitivity may still have an allergic response.
● Obtain specimens for culture and sensitivity before initiating therapy. First dose
may be given before receiving results.
● Pedi: Assess newborns for jaundice and hyperbilirubinemia; can increase biliru-
binemia and should not be administered to jaundiced neonates, especially prema-
ture neonates.
● Observe patient for signs and symptoms of anaphylaxis (rash, pruritus,
laryngeal edema, wheezing). Discontinue the drug and notify health
care professional immediately if these symptoms occur. Keep epineph-
rine, an antihistamine, and resuscitation equipment close by in the event
of an anaphylactic reaction.
● Monitor bowel function. Diarrhea, abdominal cramping, fever, and
bloody stools should be reported to health care professional promptly
as a sign of pseudomembranous colitis. May begin up to several weeks
following cessation of therapy.
● Lab Test Considerations: May cause positive results for Coombs’ test.
● May cause increased serum AST, ALT, alkaline phosphatase, bilirubin, LDH, BUN,
and creatinine.
● May rarely cause leukopenia, neutropenia, agranulocytosis, thrombocytopenia,
eosinophilia, lymphocytosis, and thrombocytosis.
Potential Nursing Diagnoses
Risk for infection (Indications) (Side Effects)
Diarrhea (Adverse Reactions)
Implementation
● Do not confuse ceftriaxone with cefazolin, cefoxitin, cefotetan, or cefta-
zidime.
● IM: Reconstitute IM doses with sterile water for injection, or 0.9% NaCl for injec-
tion. May be diluted with lidocaine to minimize injection discomfort.
● Inject deep into a well-developed muscle mass; massage well.
IV Administration
● pH: 6.6– 6.7.
● IV: Monitor injection site frequently for phlebitis (pain, redness, swelling).
Change sites every 48– 72 hr to prevent phlebitis.
Plate # 0-Composite pg 2 # 2
possible, at least 1 hr apart. If second site is unavailable, flush lines between med-
ications. PDF Page #2
● Intermittent Infusion: Diluent: Reconstitute each 250-mg vial with 2.4 mL,
each 500-mg vial with 4.8 mL, each 1-g vial with 9.6 mL, and each 2-g vial with
19.2 mL of sterile water for injection, 0.9% NaCl, or D5W for a concentration of
100 mg/mL. Solution should be further diluted in 50– 100 mL of 0.9% NaCl, D5W,
D10W, D5/0.45% NaCl, or D5/0.9% NaCl. Solution may appear light yellow to am-
ber. Solution is stable for 3 days at room temperature . Rate: Infuse over 30 min.
● Y-Site Compatibility: acyclovir, alfentanil, allopurinol, amifostine, aminoca-
proic acid, aminophylline, amiodarone, amphotericin B lipid complex, ampho-
tericin B liposome, anidulafungin, argatroban, atracurium, atropine, aztreonam,
benztropine, bivalirudin, bumetanide, buprenorphine, butorphanol, carboplatin,
carmustine, cefazolin, cefonocid, cefoperazone, cefotaxime, cefotetan, cefoxitin,
ceftazidime, cefuroxime, cisatracurium, cisplatin, cyanocobalamin, cyclophos-
phamide, cyclosporine, cytarabine, dactinomycin, daptomycin, dexamethasone,
dexmedetomidine, digoxin, diltiazem, docetaxel, dopamine, doxacurium, doxo-
rubicin liposome, doxycycline, enalaprilat, ephedrine, epinephrine, epoetin alfa,
epitifibitide, erythromycin, esmolol, etoposide, etoposide phosphate, fenoldo-
pam, fentanyl, fludarabine, fluorouracil, folic acid, foscarnet, furosemide, gem-
citabine, glycopyrrolate, granisetron, heparin, hetastarch, hydrocortisone, hydro-
morphone, ifosfamide, indomethacin, insulin, isoproterenol, ketorolac,
levofloxacin, lidocaine, linezolid, lorazepam, mannitol, mechlorethamine, mel-
phalan, meperidine, metaraminol, methotrexate, methoxamine, methyldopate,
methylprednisolone, metoclopramide, metoprolol, metronidazole, midazolam,
milrinone, morphine, multivitamins, nafcillin, nalbuphine, naloxone, nesiritide,
nitroglycerin, nitroprusside, norepinephrine, octreotide, oxacillin, oxaliplatin,
oxytocin, paclitaxel, palonosetron, pamidronate, pantoprazole, pemetrexed, pen-
icillin G, phenobarbital, phentolamine, phenylephrine, phytonadione, potassium
acetate, potassium chloride, procainamide, propofol, propranolol, pyridoxime,
ranitidine, remifentanil, rituxumab, rocuronium, sargramostim, sodium acetate,
sodium bicarbonate, streptokinase, succinylcholine, sufentanil, tacrolimus, tela-
vancin, teniposide, theophylline, thiamine, thiotepa, ticarcillin/clavulanate, tige-
cycline, tirofiban, tolazoline, trastuzumab, trimethaphan, vasopressin, vecuro-
nium, verapamil, vincristine, voriconazole, warfarin, zidovudine, zoledronic acis.
● Y-Site Incompatibility: alemtuzumab, amphotericin B cholesteryl, amsacrine,
ascorbic acid, azathioprine, azithromycin, calcium chloride, calcium gluconate,
䉷 2015 F.A. Davis Company CONTINUED
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PDF Page #3
CONTINUED
cefTRIAXone
caspofungin, chloramphenicol, chlorpromazine, clindamycin, dantrolene, diaze-
pam, diazoxide, diphenhydramine, dobutamine, doxorubicin hydrochloride, epi-
rubicin, filgrastim, ganciclovir, haloperidol, hetastarch, hydralazine, hydroxyzine,
idarubicin, imipenem/cilastatin, irinotecan, labetalol, magnesium sulfate, mito-
xantrone, mycophenolate, pentamidine, pentazocine, pentobarbital, phenytoin,
prochlorperazine, promethazine, protamine, quinupristin/dalfopristin, tobramy-
cin, trimethoprim/sulfamethoxazole, vinorelbine, Calcium-containing solutions,
including parenteral nutrition, should not be mixed or co-administered, even via
different infusion lines at different sites in patients ⬍28 days old. In older patients,
flush line thoroughly between infusions.
Patient/Family Teaching
● Advise patient to report signs of superinfection (furry overgrowth on the tongue,
vaginal itching or discharge, loose or foul-smelling stools) and allergy.
● Instruct patient to notify health care professional if fever and diarrhea
develop, especially if diarrhea contains blood, mucus, or pus. Advise pa-
tient not to treat diarrhea without consulting health care professional.
Evaluation/Desired Outcomes
● Resolution of the signs and symptoms of infection. Length of time for complete res-
olution depends on the organism and site of infection.
● Decreased incidence of infection when used for prophylaxis.
Why was this drug prescribed for your patient?

⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.