Triject

(Ceftriaxone Sodium)

Role in Pneumonia

Dr. Muhammad Ali Akbar

Product Manager
Community-Acquired
Pneumonia
 Community - Acquired Pneumonia

 An important cause of death, especially in older

adults and those with co-morbid diseases 1
 Leading cause of death due to infectious diseases
in developed countries2
 Costs of care are significantly higher for non-
survivors than for survivors2
 S. pneumoniae is the leading cause of CAP,
particularly in bacteremic and fatal episodes 2
1. J.-H. Song et al. International Journal of Antimicrobial Agents 31 (2008) 107-114
2. Intensive Care Med (2006) 32:971–980
 Microbial causes of CAP, by site of care

Outpatients Hospitalized patients

Non ICU ICU
Streptococcus S. pneumoniae S. pneumoniae
pneumoniae
Mycoplasma M. pneumoniae Staphylococcus
pneumoniae aureus
Haemophilus Chlamydophila Legionella spp.
influenzae pneumoniae
Respiratory viruses H. influenzae Gram-negative bacilli
Legionella spp. H. influenzae
Respiratory viruses

Mandell Lionel A, Wunderink Richard, "Chapter 251. Pneumonia" (Chapter). Fauci AS, Braunwald E, Kasper DL, Hauser SL,
Longo DL, Jameson JL, Loscalzo J: Harrison's Principles of Internal Medicine, 17th Edition:
http://www.accessmedicine.com/content.aspx?aID=2899132.
 Risk factors for increased morbidity &
mortality

 Advanced age
 Alcoholism
 Comorbid medical conditions
 Altered mental status
 RR ≥ 30 breaths/min
 Hypotension; Systolic < 90 or Diastolic < 60 mm Hg
 BUN > 30 mg/dl

Current Medical Diagnosis & Treatment 2008

 Recommended empiric treatment in
Inpatients, ICU

A β-lactam [ceftriaxone (2 g IV od), cefotaxime

(1–2 g IV q8h), ampicillin-sulbactam (2 g IV q8h)]

Plus

Macrolide or Fluoroquinolone

Mandell Lionel A, Wunderink Richard, "Chapter 251. Pneumonia" (Chapter). Fauci AS, Braunwald E, Kasper DL,
Hauser SL, Longo DL, Jameson JL, Loscalzo J: Harrison's Principles of Internal Medicine, 17th Edition:
http://www.accessmedicine.com/content.aspx?aID=2899132.
 Recommended empirical treatment in
Inpatients, general ward care

A β-lactam (ceftriaxone or cefotaxime)

Plus

Macrolide or Fluoroquinolone

Alternative: Ampicillin-sulbactam or piperacillin-

tazobactam

Plus

Macrolide

Current Medical Diagnosis & Treatment 2008

 Antibacterial activity of Ceftriaxone

 Successful empiric therapy against resistant strains is the

top priority to manage CAP to avoid treatment failure and
subsequent associated costs
 Ceftriaxone had the best activity against penicillin-resistant
S. pneumoniae and β-lactamase-negative and β-
lactamase-producing ampicillin-resistant H. influenzae

 Ceftriaxone offers the advantage of once daily dosing

rather than multiple divided doses, the major factor
responsible for its cost effectiveness when compared to
other 3rd and 4th generation cephalosporins
Ohno A et al. J Infect Chemother (2007) 13: 296-301
Hospital-Acquired
Pneumonia
 Hospital-Acquired Pneumonia

 One of the most common nosocomial infections

 15% of all hospital-acquired infections
 Nosocomial pneumonia is a frequent lethal
complication of hospitalization
 At a rate of 3 to 10 cases per 1000 hospital
admissions, may increase a patient’s hospital stay
by more than a week

Kieninger AN, Lipsett PA. HAP: Pathophysiology, Diagnosis and Treatment.

Surg Clin N Am 89 (2009) 439–461
 Initial approach to empirical
antibiotic therapy

HAP suspected

Evaluation
Risk factor for MDR pathogens
Time of onset (early or late)
Local microbiologic data & resistance patterns
Patient status
LRT sample gram stain
Allergy to medication
Underlying comorbidities
Formulary restrictions
Cost

Select empirical antibiotic therapy

Song J. and the Asian HAP Working Group .Am J Infect Control 2008:36:S83-92
 Early-onset HAP

 Occurring within the first 4 days of hospitalization

 Likely pathogens:
 Streptococcus pneumoniae
 Haemophilus influenzae
 MRSA, and
 antibiotic-susceptible enteric Gram-negative bacilli (ie,
Escherichia coli, Klebsiella pneumoniae, Enterobacter
species, Proteus species, or Serratia marcescens)

Song J. and the Asian HAP Working Group .Am J Infect

Control 2008:36:S83-92
 Early-onset HAP

 Recommended treatment
Ceftriaxone, cefotaxime or
Fluoroquinolone (levofloxacin, moxifloxacin,
ciprofloxacin) or
β-lactam / β-lactamase inhibitor or
Ertapenem or
Third generation cephalosporins plus macrolide

Song J. and the Asian HAP Working Group .Am J Infect

Control 2008:36:S83-92
 Late-onset HAP

 Occurring 5 days or more after hospitalization

 Likely to be caused by MDR pathogens

 P. aeruginosa
 extended-spectrum beta lactamase K. pneumoniae
 Acinetobacter species
 MRSA, and
 L. pneumophila

 Associated with increased morbidity & mortality

Song J. and the Asian HAP Working Group .Am J Infect

Control 2008:36:S83-92
 Late-onset HAP

 Recommended treatment
 third- or fourth generation cephalosporins or
 carbapenems (imipenem or meropenem) or
 piperacillin/tazobactam

plus

 fluoroquinolones or
 aminoglycosides, +/-
 glycopeptides (vancomycin or teicoplanin) or linezolid

Song J. and the Asian HAP Working Group .Am J Infect

Control 2008:36:S83-92
 Duration of treatment in HAP

 Initial empirical antibiotic treatment should

continue

for 7 to 14 days.

If an MDR pathogen is identified, then for up to

14 days.

Song J. and the Asian HAP Working Group .Am J Infect

Control 2008:36:S83-92
 Success rates of Ceftriaxone

93%
RTI
100%
Meningitis
100%
Typhoid
99%
Indications

UTI
100%
Gynaecological Infections
93%
Skin & Soft tissue Infections
100%
Gonorrhea

88% 90% 92% 94% 96% 98% 100%

% Success
Ceftriaxone Sodium
 Mode of Action

 Ceftriaxone sodium for Injection is sterile, non-pyrogenic, semi-

synthetic, broad-spectrum antibiotic for IV / IM administration

 Belongs to the 3rd Generation Cephalosporin class of drugs

 Bactericidal in nature, Inhibits cell wall synthesis

Product Monograph Triject

 Pharmacokinetics

 50-60% of Triject is excreted unchanged by the kidney

 40-50% of Triject is excreted unchanged in the bile

 In patients with renal failure the pharmacokinetics of Triject

are minimally altered. If kidney function alone is impaired,
biliary elimination of Triject is increased; if liver function is
alone impaired renal elimination is increased

Product Monograph Triject

 Effective Against

 Gram positive bacteria

 Staphylococcus aureus (including penicillinase producing
strains)

 Staphylococcus epidermidis

 Streptococcus pneumoniae

 Streptococcus viridans

 Streptococcus bovis

Product Monograph Triject

 Effective Against

 Gram negative bacteria

 Neisseria gonorrhea
 Neisseria meningitides
 Escherichia coli
 Haemophilus influenzae (including penicillinase-producing
strains)
 Proteus mirabilis
 Proteus vulgaris
 Salmonella Typhi & Paratyphi
 Pseudomonas Aeruginosa
Product Monograph Triject
 Indications
 Lower respiratory tract
infections
 Acute bacterial otitis
media
 Skin and skin structure
infections
 Urinary tract infections
 Uncomplicated gonorrhea
Product Monograph Triject
 Pelvic inflammatory
disease
 Bacterial septicemia
 Bone and joint infections
 Intra-abdominal infections
 Meningitis
 Surgical prophylaxis
Available Formulations
 Available Formulations

 Triject 250mg I.V.

 Pack of one vial containing Ceftriaxone 250mg + one ampoule of
5ml Water for Injection B.P.
 Triject 500mg I.V.:
 Pack of one vial containing Ceftriaxone 500mg + one ampoule of
5ml Water for Injection B.P.
 Triject 1g I.V.:
 Pack of one vial containing Ceftriaxone 1g + two ampoules of 5ml
Water for Injection B.P.
 Triject 250mg I.M.:
 Pack of one vial containing Ceftriaxone 250mg + one ampoule of
2ml lignocaine hydrochloride B.P.
 Triject 500mg I.M.:
 Pack of one vial containing Ceftriaxone 500mg + one ampoule of
2ml lignocaine hydrochloride B.P.

Product Monograph Triject

Comparative
Studies
 Study Title

Differences between Ceftriaxone and

Cefotaxime:
Microbiological inconsistencies

Gums JG, Boatwright DW, Camblin M, et. al.

Annals of Pharmacotherapy 2008

 Ceftriaxone – coverage x2

 Objective
 To review data to determine why pneumococcal isolates
appear to be increasingly resistant to cefotaxime

 Result
 In areas with high rates of PRSP, S. pneumoniae
isolates were twice as susceptible to ceftriaxone versus
cefotaxime

Gums JG, Boatwright DW, Camblin M, et. al. – Annals of Pharmacotherapy 2008
 Study Title

In vitro activities of cefotaxime,

ceftriaxone, ceftazidime, cefpirome, &
penicillin against S. pneumoniae isolates

Barry AL, Brown SD, Novick WJ

Antimicrobial Agents & Chemotherapy 1995

 Ceftriaxone – activity x8-16

 Objective
 To evaluate in vitro activities of four cephalosporins &
benzyl penicillin against 698 clinical isolates of S.
pneumoniae

 Result
 Ceftazidime was 8-16 fold less active than ceftriaxone
and cefotaxime against S. pneumoniae
 Clinical utility of Ceftazidime might be limited to PSSP

Barry AL, Brown SD, Novick WJ – Antimicrobial Agents & Chemotherapy 1995
 Study Title

The use of IM cefoperazone versus

IM ceftriaxone in pts. with nursing
home-acquired pneumonia

Phillips SL, Branaman-Phillips J.

Journal of the American Geriatrics Society 1993

 Cefoperazone vs Ceftriaxone

 Objective
 To compare the efficacy & safety of IM cefoperazone & IM
ceftriaxone in the treatment of nursing home-acquired
pneumonia

 Result
 Clinical cure was seen in:
 90% of cefoperazone treatment group
 94% of ceftriaxone treatment group

 Both agents were well tolerated

Phillips SL, Branaman-Phillips – Journal of the American Geriatrics Society 1993

 Ceftriaxone Brands
Price Comparison of Top Selling

http://epharmaguide.com/RBOnline/Default.aspx. Last accessed on Oct 18, 2010

Disclaimer

The material presented here does not reflect the views of the speaker or Nabiqasim Industries. These materials may discuss uses
and dosages for therapeutic products that have not been approved by the United States Food and Drug Administration. A qualified
health care professional should be consulted before using any therapeutic product discussed. All readers and continuing education
participants should verify all information and data before treating patients or employing any therapies described in this continuing
medical education activity.