A Drug Study on 

Ceftriaxone

In Partial Fulfillment of the

Requirements in NCM 209 – RLE 

PEDIATRIC NURSING ROTATION 

Submitted to:

Monica Kristine Reyes, RN

Clinical Instructor 

Submitted by: 

Oliveros, Leoneil B.

BSN – 2I Group 2

January 22, 2021

Generic name: Ceftriaxone

Brand names: Rocephin

Classification:

 Pharmacologic class: Third-generation cephalosporin

 Chemical class: 7-aminocephalosporanic acid.
 Therapeutic class: Antibiotic
 Pregnancy category: B

Ordered dose and Frequency:

 For I.V. Infusion, I.M. injection (children)- 50 to 75 mg/kg daily in divided doses
every 12 hr. Maximum of 2 g daily.

For Meningitis treatment:

 Give I.M. or I.V. (children)- Initially, 100 mg/kg/day I.M. or I.V. (should not to
exceed 4 g). Then 100 mg/kg/day I.M. or I.V. once daily or in equally divided
doses q 12 hours (should not exceed 4 g) for 7 to 14 days.

For acute bacterial otitis media treatment:

 Give Intramuscular (children)- 50 mg/kg, given as a single dose. Maximum of 1

g/dose.

For skin and skin-structure infections treatment:

 Give I.V. or I.M. (children)- 50 to 75 mg/kg/day I.V. or I.M. once or twice daily.
Maximum dosage of 2 g daily.

For infection of Epiglottis treatment:

 Give I.V.- 100 mg/kg/day on first day, follow with 50 mg/kg on day 2 or 75 mg/kg
qday, give for 10-14 days. 

For treatment of other serious infections:

  Give I.V. or I.M. (Children): 50 to 75 mg/kg/day. once or twice daily.

For Gonococcal Infections in neonates:

 Ophthalmia neonatorum; Give I.V/I.M- 25-50 mg/kg once; not to exceed 125 mg.
 Disseminated gonococcal infections and gonococcal scalp abscesses; Give
I.V./I.M.- 25-50 mg/kg/day in single daily dose for 7 days; if meningitis is
documented, treat for 10-14 days.
 Prophylaxis for infants of mothers with gonococcal infection; Give I.V./I.M.- 25-50
mg/kg IV/IM once, do not exceed 125 mg.
For Gonococcal Infections in children:
 For children weighing less than 45 kg with uncomplicated gonococcal
vulvovaginitis, cervicitis, urethritis, pharyngitis, or proctitis- give 125 mg I.M. once
 For children weighing less than 45 kg with bacteremia or arthritis- give 50
mg/kg/day I.M./I.V. in single daily dose for 7 days, daily dose should not exceed
1 g.
 For children weighing more than 45 kg with bacteremia or arthritis: 50 mg/kg/day
I.M./I.V. in single daily dose for 7 days.
 Other gonococcal infections for children weighing more than 45 kg- give 1-2 g
I.V. q12hr.

Suggested dose (by manufacturer):

Newborn babies (0-14 days):

 20 – 50 mg Rocephin for each kg of the child’s body weight once a day
depending on the severity and type of infection.
 The maximum daily dose is not to be more than 50 mg for each kg of the baby’s
weight
Newborn babies, infants and children aged 15 days to 12 years with a body weight of
less than 50 kg:
 50-80 mg Rocephin for each kg of the child’s body weight once a day depending
on the severity and type of infection. If you have a severe infection, your doctor
 will give you a higher dose up to 100 mg for each kg of body weight to a
maximum of 4 g once a day. If your daily dose is higher than 2 g, you may
receive it as a single dose once a day or as two separate doses.
 Children with a body weight of 50 kg or more should be given the usual adult
dose

Adults, older people and children aged 12 years and over with a body weight greater
than or equal to 50 kilograms (kg):
 1 to 2 g once a day depending on the severity and type of infection. If you have a
severe infection, your doctor will give you a higher dose (up to 4 g once a day). If
your daily dose is higher than 2 g, you may receive it as a single dose once a day
or as two separate doses.

Mode of action:

Interferes with bacterial cell wall synthesis and division by inhibiting cross-linking of
peptidoglycan strands. Peptidoglycan makes the cell membrane rigid and protective.
Without it, bacterial cells rupture and die. Active against gram-negative and gram-
positive bacteria, with expanded activity against gram-negative bacteria. Exhibits
minimal immunosuppressant activity.

Indication:

To treat infections of:

 lower respiratory tract

 skin, soft tissue
 urinary tract
 bones, and joints
 Sinusitis
 acute otitis media
  Meningitis
 Surgical prophylaxis.
 intra-abdominal infections
 septicemia

Contraindication:

 Calcium-containing I.V. solutions

 Intravenous administration of ceftriaxone solutions containing lidocaine
 hyperbilirubinemic neonates
 hypersensitivity to ceftriaxone and other cephalosporins, or their components
 neonates who are 28 days old or less if they’re expected to need calcium
containing solutions, including parenteral nutrition.

Drug interaction:

 Aminoglycosides, loop diuretics: increased risk of nephrotoxicity

 Calcium-containing solutions: possibly fatal reactions caused by ceftriaxone
calcium precipitates
 Probenecid: decreased excretion and increased blood level of ceftriaxone.

 Warfarin- ceftriaxone increases effects of warfarin by anticoagulation. 

 BCG vaccine live- ceftriaxone decreases effects of BCG vaccine live by

pharmacodynamic antagonism.
Nursing Responsibilities:

 Obtain specimens for culture and sensitivity testing as necessary before starting
therapy.
 Use ceftriaxone cautiously in patients who are hypersensitive to penicillins.
 Be aware that drug mustn’t be given with or within 48 hours of calcium-containing
I.V. solutions, including calcium-containing continuous infusions such as
parenteral nutrition, because of risk of precipitation of ceftriaxone calcium salt
(particularly in neonates).

 Inspect injection sites for induration and inflammation. Rotate sites. Note IV
injection sites for signs of phlebitis (redness, swelling, pain).
 Assess CBC, hematocrit, and serum AST, ALT, bilirubin, LD, and alkaline
phosphatase levels during long-term therapy. If abnormalities occur, notify
prescriber. Drug may need to be discontinued.
 Monitor BUN and serum creatinine levels to detect early signs of nephrotoxicity.
Also monitor fluid intake and output; decreasing urine output may indicate
nephrotoxicity.
 Monitor patient for allergic reactions throughout ceftriaxone therapy and after
drug is discontinued. Notify prescriber and stop drug, as ordered, at first sign of
an allergic reaction. Be prepared to provide supportive care, including
epinephrine administration and other emergency measures, as indicated and
ordered.
 Assess for perineal itching, fever, malaise, redness, swelling, rash, and change
in cough or sputum; they may indicate a superinfection.
 Assess bowel pattern daily; severe diarrhea may indicate pseudomembranous
colitis caused by Clostridium difficile. If diarrhea occurs, notify prescriber and
expect to treat with fluids, electrolytes, protein, and an antibiotic effective against
C. difficile. Ceftriaxone therapy may be withheld also.
 Instruct patient to report persistent diarrhea, bruising, or bleeding.
 Caution patient not to use herbs unless prescriber approves.
References:

 Rocephin (ceftriaxone) dosing, indications, interactions, adverse effects, and more.

(2020, January 23). Retrieved January 22, 2021, from
https://reference.medscape.com/drug/rocephin-ceftriaxone-342510#3
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clinical knowledge, & Here, P. (2020, September 08). Ceftriaxone Drug Study. Retrieved
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