Ceftriaxone

DEA Class; Rx

Common Brand Names; Rocephin (DSC)

Indicated for the treatment of bacteremia and sepsis.

Documented hypersensitivity; hyperbilirubinemic neonates, particularly those who are premature; neonates <28 days if they receive calcium-containing IV products

Intravenous administration of ceftriaxone solutions containing lidocaine

Lidocaine contraindications if lidocaine solution used as solvent with ceftriaxone for intramuscular injection

• Induration after IM injection (5-17%)
• Eosinophilia (6%)
• Thrombocytosis (5%)
• Diarrhea (3%)
• Elevated hepatic transaminases (3%)
• Leukopenia (2%)
• Rash (2%)
• Increased blood urea nitrogen (BUN) (1%)
• Induration at IV site (1%)
• Pain (1%)
• Agranulocytosis
• Anaphylaxis
• Anemia
• Basophilia
• Bronchospasm
• Candidiasis
• Chills
• Diaphoresis
• Dizziness
• Dysgeusia
• Flushing
• Gallstones
• Glycosuria
• Headache
• Hematuria
• Hemolytic anemia
• Increased alkaline phosphatase or bilirubin
• Increased creatinine
• Jaundice
• Leukocytosis
• Lymphocytosis
• Lymphopenia
• Monocytosis
• Nausea
• Neutropenia
• Phlebitis
• Prolonged or decreased prothrombin time (PT)
• Pruritus
• Renal stones
• Serum sickness
• Thrombocytopenia
• Urinary casts
• Vaginitis
• Vomiting

10-g pharmacy bulk package should not be used for direct infusion

Immune-mediated hemolytic anemia reported; if patient develops anemia while on ceftriaxone, stop antibiotic until etiology determined; severe hemolytic anemia, including fatalities, reported in both adults and children

May increase INR, especially in nutritionally deficient patients, hepatic or renal disease or prolonged treatment

Dosage must be adjusted in severe renal insufficiency (high dosages may cause CNS toxicity)

Superinfections and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy

Use with caution in patients with history of penicillin allergy

Use with caution in patients with history of GI disease, especially colitis

Use with caution in breast-feeding women; drug may displace bilirubin from albumin-binding sites, increasing risk of kernicterus

Abnormal gallbladder sonograms reported, possibly the result of ceftriaxone-calcium precipitates; discontinue if signs or symptoms of gallbladder disease occur

Ceftriaxone-calcium precipitates in urinary tract observed in patients receiving ceftriaxone; may be detected as sonographic abnormalities; patients may be asymptomatic or may develop symptoms of urolithiasis, and ureteral obstruction and post-renal acute renal failure; appears to be reversible upon discontinuation of therapy and institution of appropriate management; ensure adequate hydration; discontinue therapy in patients who develop signs and symptoms suggestive of urolithiasis, oliguria or renal failure and/or the sonographic findings

Available data from published prospective cohort studies, case series, and case reports over several decades in pregnant women have not established a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes

Data from published literature report that ceftriaxone is present in human milk; there are no data on effects of drug on breastfed child or on milk production