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
1g
 >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
  intra-abdominal infections and septicemia caused by anaerobes (including
Bacteroides bivius, Bacteroides fragilis, Bacteroides melaninogenicus, and
Peptostreptococcus species)
 gram negative organisms (including Citrobacter species, Enterobacter
aerogenes, Escherichia coli, Haemophilus influenzae, Klebsiella species,
Neisseria species, Proteus mirabilis, Proteus vulgaris, Providencia species,
Salmonella species, Serratia marcescens, Shigella, and some strains of
Pseudomonas aeruginosa)
 gram-positive organisms (including Staphylococcus aureus, Streptococcus
pneumoniae, and Streptococcus pyogenes)

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.
 Hypersensitivity to drug, benzyl alcohol, bisulfites, EDTA, creatinine, polysorbate
80, or methylparaben
 Systemic fungal infections
 Active or suspected ocular or periocular infections, advanced glaucoma
(intravitreal implant)

Side effects:

 vision changes,
 swelling,
 rapid weight gain,
 sleep problems (insomnia),
  mood changes,
 acne,
 dry skin,
 thinning skin,
 bruising or discoloration,
 slow wound healing,
 increased sweating,
 headache,
 dizziness,
 spinning sensation,
 nausea,
 stomach pain,
 bloating,
 muscle weakness, or
 changes in the shape or location of body fat (especially in your arms, legs, face,
neck, breasts, and waist).

Adverse effect:

 CNS: headache, malaise, vertigo, psychiatric disturbances, increased intracranial pressure,

seizures
 CV: hypotension, thrombophlebitis, myocardial rupture after recent myocardial infarction,
thromboembolism
 EENT: cataracts; elevated intraocular pressure (IOP), conjunctival hemorrhage (with intravitreal
implant)
 GI: nausea, vomiting, abdominal distention, dry mouth, anorexia, peptic ulcer, bowel
perforation, pancreatitis, ulcerative esophagitis
 Metabolic: decreased carbohydrate tolerance, hyperglycemia, cushingoid appearance (moon
face, buffalo hump), decreased growth (in children), latent diabetes mellitus, sodium and fluid
retention, negative nitrogen balance, adrenal suppression, hypokalemic alkalosis
 Musculoskeletal: muscle wasting, muscle pain, osteoporosis, aseptic joint necrosis, tendon
rupture, long bone fractures
 Skin: diaphoresis, angioedema, erythema, rash, pruritus, urticaria, contact dermatitis, acne,
decreased wound healing, bruising, skin fragility, petechiae Other: facial edema, weight gain or
loss, increased susceptibility to infection, hypersensitivity reactions.

Drug interaction: