Ceftriaxone

C. diff Risk

High

Oral Bioavailability

NA

Approximate Cost

$3/day

Dosing

Neonatal

Cefotaxime is preferred in neonates due to the risk of bilirubin encephalopathy (kernicterus) and fatal reactions caused by calcium-ceftriaxone precipitates.

General Information

Common Usage

Empiric therapy of bacterial meningitis, complicated community acquired pneumonia, nosocomial Gram negative infections (except Pseudomonas)

Adverse Effects

  • Allergy,rash (immediate or delayed)

  • Cytopenias, eosinophilia

  • Hepatic (biliary) and renal laboratory abnormalities

  • Pseudocholelithiasis

Major Interactions

Calcium containing IV solutions bind to ceftriaxone forming an insoluble precipitate- avoid concurrent use with calcium containing solutions in neonates.
Ceftriaxone should not be mixed with calcium-containing IV solutions, including TPN and Ringer’s solution.

Additional Information

IM ceftriaxone may be given with 1% lidocaine to minimize pain at injection site

Pharmacology

Antimicrobial class: Parenteral Cephalosporin - 3rd Generation

Route of Elimination: Unchanged in the urine (33-67%) by glomerular filtration and in feces via bile.

Average serum half life:

  • Neonates: 1-4 days: 16 hours; 9-30 days: 9 hours

  • Pediatrics: 4.1-6.6h