ceftriaxone

Generic Name: ceftriaxone (SEF trye AX one)Brand names: Rocephin, Rocephin IM Convenience Kit (obsolete)

What is ceftriaxone injection?

Ceftriaxone is in a group of drugs called cephalosporin (SEF a low spor in) antibiotics. It works by fighting bacteria in your body.

Ceftriaxone injection is used to treat many kinds of bacterial infections, including severe or life-threatening forms such as meningitis.

Ceftriaxone may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about ceftriaxone injection?Do not use this medication if you are allergic to ceftriaxone, or to similar antibiotics, such as Ceftin, Cefzil, Keflex, Omnicef, and others.

Before using this medication, tell your doctor if you are allergic to any drugs (especially penicillin). Also tell your doctor if you have liver or kidney disease, gallbladder problems, a stomach or intestinal disorder, or if you are malnourished.

Use this medication for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated. Ceftriaxone is usually continued for at least 2 days after symptoms disappear.

Ceftriaxone will not treat a viral infection such as the common cold or flu.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.

What should I discuss with my health care provider before using ceftriaxone injection?Do not use this medication if you are allergic to ceftriaxone, or to other cephalosporin antibiotics, such as:

• cefaclor (Raniclor);

• cefadroxil (Duricef);

• cefazolin (Ancef);

• cefdinir (Omnicef);

• cefditoren (Spectracef);

• cefpodoxime (Vantin);

• cefprozil (Cefzil);

• ceftibuten (Cedax);

• cefuroxime (Ceftin);

• cephalexin (Keflex); or

• cephradine (Velosef).

If you have certain conditions, you may need a dose adjustment or special tests to safely use this medication. Before using ceftriaxone, tell your doctor if you are allergic to any drugs (especially penicillins), or if you have:

• kidney disease (or if you are on dialysis);
• liver disease;

• gallbladder problems;

• a stomach or intestinal disorder such as colitis; or

• if you are malnourished.

FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Ceftriaxone can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Do not use ceftriaxone in a child without a doctor's advice, and never give more than the child's prescribed dose.

How should I use ceftriaxone injection?

Ceftriaxone is given as an injection into a muscle or a vein. Your doctor, nurse, or other healthcare provider will give you this injection. You may be given instructions on how to use your injections at home. Do not use this medicine at home if you do not fully understand how to give the injection and properly dispose of needles, syringes, and other items used in giving the medicine.

Use the medication exactly as it was prescribed for you. Do not use it in larger amounts or use it for longer than recommended by your doctor. Follow the instructions on your prescription label.

You will need to mix ceftriaxone with a liquid (diluent) before using it. If you are using the injections at home, be sure you understand how to properly mix and store the medication. Use only the diluent your doctor has recommended.

Do not mix ceftriaxone with any diluent that contains calcium, including a TPN (total parenteral nutrition) solution.

Use this medication for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated. Ceftriaxone is usually continued for at least 2 days after symptoms disappear.

Ceftriaxone will not treat a viral infection such as the common cold or flu.

Store this medicine at room temperature, away from moisture, heat, and light.

If your medicine was provided in a frozen form or was frozen after mixing, thaw it in a refrigerator or at room temperature. Do not warm in a microwave or boiling water. Use the medicine as soon as possible after thawing it. Do not refreeze.

What happens if I miss a dose?

Use the medication as soon as you remember the missed dose. If it is almost time for your next dose, skip the missed dose and use the medicine at your next regularly scheduled time. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

What should I avoid while using ceftriaxone injection?

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.

Ceftriaxone injection side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:

• diarrhea that is watery or bloody;

• fever or chills;

• skin rash, bruising, severe tingling, numbness, pain, muscle weakness;

• blistering, peeling, and red skin rash;

• white patches or sores inside your mouth or on your lips;

• pale or yellowed skin, dark colored urine, confusion or weakness;

• urinating less than usual or not at all;

• swelling, pain, or irritation where the injection was given; or

• chalky-colored stools, stomach pain just after eating a meal, nausea, heartburn, bloating, and severe upper stomach pain that may spread to your back.

Less serious side effects may include:

• nausea, vomiting, stomach pain;

• headache, dizziness;

• pain or swelling in your tongue;

• sweating; or

• vaginal itching or discharge.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Ceftriaxone Dosing Information

Usual Adult Dose for Bacteremia:

2 g IV every 24 hours for 14 days, depending on the nature and severity of the infection

Usual Adult Dose for Chancroid:

250 mg IM as a single doseThe causative organism is Haemophilus ducreyi.HIV-infected patients may require longer treatment. Ceftriaxone should only be given if patient follow-up can be guaranteed.Patients should be retested for syphilis and HIV in 3 months, if initial tests were negative. The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Conjunctivitis:

Gonococcal Conjunctivitis: 1 g IM onceDoxycycline therapy for 7 days (if not pregnant) or single dose azithromycin is also recommended to treat possible concurrent chlamydial infection.The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Endocarditis:

Patients with normal renal function:Native valve infections due to highly penicillin-susceptible viridans Group Streptococci and S bovis (MIC 0.12 mcg/mL or less): Ceftriaxone 2 g IV or IM every 24 hours for 4 weeks plus gentamicin 3 mg/kg IV or IM every 24 hours for 2 weeksNative valve infections due to relatively resistant S viridans and S bovis (MIC greater than 0.12 mcg/mL and 0.5 mcg/mL or less): Ceftriaxone 2 g IV or IM every 24 hours for 4 weeks plus gentamicin 3 mg/kg IV or IM every 24 hours for 2 weeksProsthetic valve infections due to penicillin-susceptible S viridans and S bovis (MIC 0.12 mcg/mL or less): Ceftriaxone 2 g IV or IM every 24 hours for 6 weeks plus gentamicin 3 mg/kg IV or IM every 24 hours for 2 weeksProsthetic valve infections due to relatively or fully penicillin-resistant S viridans and S bovis (MIC greater than 0.12 mcg/mL): Ceftriaxone 2 g IV or IM every 24 hours for 6 weeks plus gentamicin 3 mg/kg IV or IM every 24 hours for 6 weeksNative or prosthetic valve infections due to enterococcal strains resistant to penicillin, aminoglycosides, and vancomycin: Ceftriaxone 2 g IV or IM every 24 hours plus ampicillin 2 g IV every 4 hours for 8 weeks or moreRefer to current published guidelines for detailed recommendations.

Usual Adult Dose for Bacterial Endocarditis Prophylaxis:

As an alternative in patients unable to take oral medication, with or without penicillin allergy (non-anaphylactoid type): 1 g IV or IM once 30 to 60 minutes before procedure

Usual Adult Dose for Endometritis:

2 g IV every 24 hours plus clindamycinDuration: Parenteral therapy should be continued for at least 24 hours after the patient has remained afebrile, pain free, and the leukocyte count has normalized. Doxycycline therapy for 14 days is recommended if concurrent chlamydial infection is present in late postpartum patients (breast-feeding should be discontinued).

Usual Adult Dose for Epididymitis -- Sexually Transmitted:

Gonococcal epididymitis: 250 mg IM as a single doseDoxycycline 100 mg twice daily orally for 10 days should be given to treat a concurrent chlamydial infection.The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Epiglottitis:

2 g IV every 24 hours for 7 to 10 days, depending on the nature and severity of the infection

Usual Adult Dose for Gastroenteritis:

2 g IV every 24 hoursDuration: 7 to 10 days in immunocompromised patients

Usual Adult Dose for Gonococcal Infection -- Disseminated:

1 g IV or IM every 24 hoursDuration: Parenteral therapy should be continued for 24 to 48 hours after clinical improvement is demonstrated. Oral therapy with cefixime or cefpodoxime should then be continued to complete a total course of at least 1 week.Doxycycline therapy for 7 days (if not pregnant) or single dose azithromycin is also recommended to treat possible concurrent chlamydial infection.The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Gonococcal Infection -- Uncomplicated:

Uncomplicated infections of the cervix, urethra, rectum, or pharynx: 125 mg IM onceDoxycycline therapy for 7 days (if not pregnant) or single dose azithromycin is also recommended to treat possible concurrent chlamydial infection.The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Intraabdominal Infection:

2 g IV 24 hours for 7 to 14 days, depending on the nature and severity of the infection

Usual Adult Dose for Joint Infection:

1 to 2 g IV or IM every 24 hoursDuration: 3 to 4 weeks, depending on the nature and severity of the infection; longer therapy, 6 weeks or more, may be required for prosthetic joint infections

Usual Adult Dose for Lyme Disease -- Arthritis:

2 g IV or IM every 24 hoursFebrile patients should also be evaluated/treated for human granulocytic ehrlichiosis (HGE) and babesiosis.Duration: 14 days for arthritis, up to 21 days for carditis, and up to 30 days for neurologic Lyme disease

Usual Adult Dose for Lyme Disease -- Carditis:

2 g IV or IM every 24 hoursFebrile patients should also be evaluated/treated for human granulocytic ehrlichiosis (HGE) and babesiosis.Duration: 14 days for arthritis, up to 21 days for carditis, and up to 30 days for neurologic Lyme disease

Usual Adult Dose for Lyme Disease -- Neurologic:

2 g IV or IM every 24 hoursFebrile patients should also be evaluated/treated for human granulocytic ehrlichiosis (HGE) and babesiosis.Duration: 14 days for arthritis, up to 21 days for carditis, and up to 30 days for neurologic Lyme disease

Usual Adult Dose for Meningitis:

2 g IV every 12 hours for 14 days, depending on the nature and severity of the infection

Usual Adult Dose for Meningococcal Meningitis Prophylaxis:

250 mg IM once

Usual Adult Dose for Neurosyphilis:

2 g IV or IM every 24 hours for 10 to 14 daysAqueous crystalline penicillin G is considered the drug of choice by the CDC.The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Osteomyelitis:

1 to 2 g IV or IM every 24 hoursDuration: 4 to 6 weeks, depending on the nature and severity of the infection; additional oral antibiotic therapy may be required for up to 6 months for chronic osteomyelitis

Usual Adult Dose for Pelvic Inflammatory Disease:

Outpatient treatment of mild PID: 250 mg IM once plus oral doxycycline with or without metronidazoleSevere: 1 to 2 g IV or IM every 24 hours for 14 days, depending on the nature and severity of the infectionDoxycycline therapy for 14 days (if not pregnant) is also recommended to treat possible concurrent chlamydial infection.The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Peritonitis:

2 g IV every 24 hoursPeritoneal dialysis-related peritonitis:Continuous: 1 g/2 L dialysate intraperitoneally, followed by 250 to 500 mg/2 L dialysateIntermittent: 1 g/2 L dialysate intraperitoneally every 24 hoursDuration: 10 to 14 days, depending on the nature and severity of the infection

Usual Adult Dose for Pneumonia:

1 to 2 g IV or IM 24 hours for 7 to 21 days, depending on the nature and severity of the infection

Usual Adult Dose for Prostatitis:

Gonococcal prostatitis: 250 mg IM onceDoxycycline 100 mg twice daily orally for 10 days should be given to treat a concurrent chlamydial infection.The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Pyelonephritis:

1 to 2 g IV or IM every 24 hoursDuration: 14 days, depending on the nature and severity of the infection

Usual Adult Dose for Salmonella Gastroenteritis:

2 g IV every 24 hoursDuration: Up to 14 days in immunocompromised patients, or longer if a relapse occurs

Usual Adult Dose for Sepsis:

Severe: 2 g IV every 24 hours for 14 days, depending on the nature and severity of the infection

Usual Adult Dose for Skin or Soft Tissue Infection:

Severe: 1 to 2 g IV or IM every 24 hoursDuration: 7 to 10 days, depending on the nature and severity of the infection; diabetic soft tissue infections may require treatment for 14 to 21 days

Usual Adult Dose for STD Prophylaxis:

STD prophylaxis, sexual assault: 125 mg IM once, in combination with metronidazole and azithromycin or doxycyclineSexual partner(s) of patients with chancroid: 250 mg IM once

Usual Adult Dose for Surgical Prophylaxis:

1 g IV 30 to 120 minutes before surgeryThird generation cephalosporins are generally not recommended for routine surgical prophylaxis.

Usual Adult Dose for Syphilis -- Early:

1 g IV or IM every 24 hours for 8 to 10 daysBenzathine penicillin G is considered the drug of choice by the CDC.The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Typhoid Fever:

2 g IV every 24 hoursDuration: 7 to 10 days; if the patient is immunocompromised or a relapse occurs, 14 days or more of treatment may be required

Usual Adult Dose for Urinary Tract Infection:

Severe: 1 to 2 g IV or IM every 24 hoursDuration: 2 to 3 weeks for complicated infections

Usual Pediatric Dose for Bacterial Infection:

7 days or less, 2000 g or less: 50 mg/kg IV or IM every 24 to 36 hours7 days or less, 2001 g or more: 50 mg/kg IV or IM every 24 hours8 days to 4 weeks, 2000 g or less: 50 mg/kg IV or IM every 24 hours8 days to 4 weeks, 2001 g or more: 50 to 75 mg/kg IV or IM every 24 hoursCeftriaxone should be avoided in neonates with hyperbilirubinemia.1 month or older:Severe: 50 to 75 mg/kg IV in divided doses every 12 to 24 hours (maximum dose: 2 g/24 hours)Life-threatening: 80 to 100 mg/kg IV in 1 or 2 divided doses (maximum dose: 4 g/24 hours)

Usual Pediatric Dose for Gonococcal Infection -- Uncomplicated:

Infants of mothers with gonococcal infection (gonococcal prophylaxis): 25 to 50 mg/kg (maximum dose: 125 mg) IV or IM onceCeftriaxone should be avoided in neonates with hyperbilirubinemia.Infant and mother should be evaluated/treated for possible concurrent chlamydial infection. The mother's sexual partner(s) should also be evaluated/treated.Children with uncomplicated infections of the cervix, urethra, and pharynx:17 years or less: 125 mg IM oncePatients should be evaluated/treated for possible concurrent syphilis and/or chlamydial infections.

Usual Pediatric Dose for Gonococcal Infection -- Disseminated:

0 to 4 weeks: 25 to 50 mg/kg (maximum dose: 125 mg) IV or IM every 24 hours for 7 days, up to 10 to 14 days if meningitis is documentedCeftriaxone should be avoided in neonates with hyperbilirubinemia.1 month or older:Less than 45 kg:Peritonitis, arthritis, or bacteremia: 50 mg/kg (maximum dose: 1 g) IV or IM every 24 hours for 7 daysGreater than 45 kg: 1 g IV or IM once a day for 7 days

Usual Pediatric Dose for Meningitis:

0 to 4 weeks: 50 to 75 mg/kg every 24 hoursCeftriaxone should be avoided in neonates with hyperbilirubinemia.1 month or older:Initial dose: 100 mg IV at the start of therapy (maximum dose: 4 g)Maintenance dose: 100 mg/kg/day IV once a day or in divided doses every 12 hours for 7 to 14 days (maximum dose: 4 g/24 hours)Gonococcal infection:Less than 45 kg: 50 mg/kg/day IV or IM divided every 12 hours for 10 to 14 days (maximum dose: 2 g/day)Greater than 45 kg: 1 to 2 g IV or IM every 12 hours for 10 to 14 days

Usual Pediatric Dose for Meningococcal Meningitis Prophylaxis:

12 years or less: 125 mg IM once13 years or older: 250 mg IM once

Usual Pediatric Dose for Endocarditis:

Gonococcal infection:Less than 45 kg: 50 mg/kg/day IV or IM divided every 12 hours for 28 days (maximum dose: 2 g/day)Greater than 45 kg: 1 to 2 g IV or IM every 12 hours for 28 days

Usual Pediatric Dose for Bacterial Endocarditis Prophylaxis:

As an alternative in patients unable to take oral medication, with or without penicillin allergy (non-anaphylactoid type): 50 mg/kg (maximum dose: 1 g) IV or IM once 30 to 60 minutes before procedure

Usual Pediatric Dose for Otitis Media:

Acute bacterial otitis media: 50 mg/kg IM once (maximum dose: 1 g)Persistent or relapsing acute otitis media: 50 mg/kg IV or IM once a day for 3 days (maximum dose: 1 g/day)Ceftriaxone should be avoided in neonates with hyperbilirubinemia.

Usual Pediatric Dose for Epiglottitis:

1 month or older: 50 to 100 mg/kg IV or IM once a dayDuration: Has been reported to range from 2 to 14 days

Usual Pediatric Dose for Skin and Structure Infection:

1 month or older: 50 to 75 mg/kg/day IV or IM in 1 to 2 divided doses (maximum dose: 2 g/day)

Usual Pediatric Dose for Typhoid Fever:

1 month or older: 75 to 80 mg/kg IV once a day for 5 to 14 days

Usual Pediatric Dose for Lyme Disease:

Persistent arthritis, meningitis, encephalitis: 75 to 100 mg/kg/day (maximum dose: 2 g) IV or IM for 2 to 4 weeks

Usual Pediatric Dose for Salmonella Gastroenteritis:

50 to 75 mg/kg/day IV for 2 to 5 daysTreat immunocompromised patients for up to 10 days.Ceftriaxone should be avoided in neonates with hyperbilirubinemia.

Usual Pediatric Dose for Shigellosis:

50 to 75 mg/kg/day IV for 2 to 5 daysTreat immunocompromised patients for up to 10 days.Ceftriaxone should be avoided in neonates with hyperbilirubinemia.

Usual Pediatric Dose for STD Prophylaxis:

STD prophylaxis, sexual assault:13 years or older: 125 mg IM once, in combination with metronidazole and azithromycin or doxycycline

Usual Pediatric Dose for Conjunctivitis:

Gonococcal infection:Less than 45 kg: 50 mg/kg (maximum dose: 1 g) IV or IM onceGreater than 45 kg: 1 g IM once

Usual Pediatric Dose for Chancroid:

1 month or older: 50 mg/kg (maximum dose: 250 mg) IM as a single dose

Usual Pediatric Dose for Epididymitis -- Non-Specific:

250 mg IM as a single dose

What other drugs will affect ceftriaxone injection?

There may be other drugs that can interact with ceftriaxone. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

• Your doctor or pharmacist can provide more information about ceftriaxone.

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 5.02. Revision Date: 08/03/2009 3:39:18 PM.