Pharmacy No. 84. Delivery of medicines to your home and office.

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Instructions for use CEFTRIAXONE

Adults and children over 12 years of age:

Usually 1-2 g of Ceftriaxone is prescribed 1 time / day (every 24 hours). For severe infections or infections whose pathogens are only moderately sensitive to ceftriaxone, the daily dose can be increased to 4 g.

Children

Newborns (up to 2 weeks):

20-50 mg/kg body weight 1 time/day. Considering the underdevelopment of the enzyme system, the daily dose should not exceed 50 mg/kg body weight. There are no differences when determining the dose for full-term and premature infants.

Ceftriaxone is contraindicated in neonates ≤28 days of age who need (or are expected to need) treatment with calcium-containing IV solutions, including calcium-containing IV infusions such as parenteral nutrition, due to the risk of calcium salt precipitates ceftriaxone.

Children from 15 days to 12 years:

20-80 mg/kg body weight 1 time/day. Children weighing more than 50 kg are prescribed doses as for adults.

IV doses of 50 mg/kg or higher should be administered by infusion over at least 30 minutes.

A dose of more than 80 mg/kg body weight should not be prescribed due to the increased risk of biliary precipitation.

Elderly patients

Elderly patients do not require dose adjustment.

Duration of treatment

The duration of antibacterial treatment depends on the course of the disease. Patients should continue to take Ceftriaxone for at least 48-72 hours after the temperature has normalized and/or confirmation of eradication of pathogens has been obtained.

Combination therapy

Studies have shown that there is a synergism between ceftriaxone and aminoglycosides against many gram-negative bacteria. Although the increased effectiveness of such combinations cannot always be predicted, it should be considered in the presence of severe, life-threatening infections caused by Pseudomonas aeruginosa. Due to the physical incompatibility of ceftriaxone and aminoglycosides, they should be administered separately at recommended doses.

Dosing in special cases

Meningitis

For bacterial meningitis in children aged 15 days to 12 years, treatment begins with a dose of 100 mg/kg (but not more than 4 g) 1 time/day. Once the pathogen has been identified and its sensitivity established, the dose can be reduced accordingly. The best results were achieved with the following treatment duration:

Neisseria meningitidis - 4 days;
Haemophilus influenza - 6 days;
Streptococcus pneumoniae - 7 days.

Gonorrhea

For the treatment of gonorrhea (caused by penicillinase-forming or non-penicillinase-forming strains), a single dose of 250 mg IM is recommended.

Prevention of infections in surgery

To prevent postoperative infections in surgery, it is recommended, depending on the degree of danger of infection, to administer a single dose of 1-2 g of Ceftriaxone 30-90 minutes before the start of surgery. During operations on the colon and rectum, the simultaneous (but separate) administration of the drug and one of the 5-nitroimidazoles, for example ornidazole, has worked well.

Kidney and liver failure

In patients with impaired renal function, there is no need to reduce the dose if liver function remains normal. Only in case of end-stage renal failure (creatinine clearance less than 10 ml/min) the daily dose should not exceed 2 g.

In case of simultaneous severe renal and liver failure, the concentration of ceftriaxone in the blood plasma should be regularly determined and the dose of the drug adjusted if necessary.

Patients on hemodialysis do not need additional administration of the drug after dialysis. However, the serum concentration of ceftriaxone should be monitored in relation to possible dose adjustments, since the elimination rate may be reduced in such patients. The daily dose of Ceftriaxone in patients on hemodialysis should not exceed 2 g.

Preparation of solutions

Prepare solutions immediately before use.

Freshly prepared solutions retain their physical and chemical stability for 6 hours at room temperature (or for 24 hours at a temperature of 2-8°C). Depending on the concentration and duration of storage, the color of solutions can vary from pale yellow to amber. The color of the solution does not affect the effectiveness or tolerability of the drug.

Injection

For injection, dissolve 1 g in 3.5 ml of 1% lidocaine solution; make the injection deep into the gluteal muscle. It is recommended to inject no more than 1 g into one buttock. If the indicated dose exceeds 1 g, it should be divided and administered in multiple injections.

IV injection

For injection, dissolve 1 g of the drug in 10 ml of sterile water for injection, administer intravenously slowly (2-4 minutes).

Introduction

The administration should last at least 30 minutes. To prepare a solution for infusion, dissolve 2 g of Ceftriaxone in 40 ml of one of the following infusion solutions free of calcium ions:

0.9% sodium chloride, 0.45% sodium chloride + 2.5% glucose, 5% glucose, 10% glucose, 6% dextran in 5% glucose solution, 6-10% hydroxyethyl starch, water for injection. Due to possible incompatibility, solutions containing ceftriaxone should not be mixed with solutions containing other antibiotics, either during preparation or during administration.

Solvents containing calcium, such as Ringer's solution or Hartmann's solution, should not be used to dissolve the drug in vials or to dilute the reconstituted solution for intravenous administration due to the possibility of the formation of precipitates of ceftriaxone calcium salts. Precipitates of ceftriaxone calcium salts can also occur when ceftriaxone is mixed with solutions containing calcium in the same infusion system for intravenous administration.

Ceftriaxone should not be coadministered with solutions containing calcium, including long-term infusions containing calcium, such as parenteral nutrition.

Instructions for Ceftriaxone injections

The abstract requires compliance with the following dosages:

for children over 12 years of age and adults – from 1 to 2 g per day, once or half the volume with an interval of 12 hours;
in severe cases - up to 4 g per day;
for the treatment of gonorrhea - intramuscular single injection of 250 mg of the drug;
for preventive purposes before surgery - 1-2 g of medication 30-180 minutes before surgery;
for two-week-old babies - once, for every kilogram of body weight from 20 to 50 mg (the latter figure is the maximum allowable dosage).

For children weighing over 50 kg, doses similar to adults are recommended. In other cases, the calculation is based on body weight - from 20 to 75 mg per kilogram per day.

Dosages requiring the use of Ceftriaxone in volumes greater than 50 mg are prescribed as an intravenous drip. Therapy is carried out for 30 minutes or more. Treatment of bacterial meningitis begins with a loading dose of 100 mg per kg per day (the maximum amount cannot exceed 4 g). After determining the pathogen and its sensitivity to the antibiotic, the regimen is changed downwards.

The duration of therapy depends on the type of pathogenic microflora and the characteristics of the clinical manifestations of the disease. With gram-negative microorganisms, the effect is achieved in 4 days, when fighting enterobacteria - in 2 weeks.

The drug is diluted with 1-2% lidocaine solution or water for injection. The latter option is used for patients with allergies to the anesthetic. In other cases, preference is given to a solution containing Lidocaine or Novocaine due to the pain of the injections and the persistence of discomfort for some time after the injection.

The antibiotic is manufactured only for parenteral use; there are no tablets or suspensions. The problem is related to the reaction of body tissues to the component composition of Ceftriaxone - when attempting to introduce the medication, severe irritation and high activity of the drug ingredients are observed.

Ceftriaxone

The drug is administered intramuscularly or intravenously.

Standard dosage regimen

For adults and children over 12 years old:

The average daily dose is 1-2 g of ceftriaxone once a day (every 24 hours).

In severe cases or in cases of infections caused by moderately susceptible pathogens, the single daily dose may be increased to 4 g.

For newborns (up to two weeks of age): 20-50 mg/kg body weight once a day (the dose of 50 mg/kg body weight is not allowed to be exceeded due to the immature enzyme system of newborns). When determining the dose, there is no need to distinguish between full-term and premature infants.

For infants and children up to 12 years of age (from 15 days to 12 years): the daily dose is 20-80 mg/kg body weight.

In children weighing 50 kg or more, adult doses should be prescribed. The drug at a dose of 50 mg/kg body weight or more must be administered as an intravenous infusion over at least 30 minutes.

Elderly patients: usual doses for adults, not adjusted for age.

The duration of treatment depends on the course of the disease. As always with antibiotic therapy, the administration of ceftriaxone should be continued in patients for at least 48-72 hours after the temperature has normalized and eradication of the pathogen has been confirmed.

Dosing in special cases:

Meningitis:

For bacterial meningitis in infants and young children, the initial dose is 100 mg/kg body weight once daily (maximum 4 g). Once the pathogen has been isolated and its sensitivity has been determined, the dose must be reduced accordingly.

The best results were achieved with the following periods of therapy:

Pathogen	Duration of therapy
Neisseria meningitidis	4 days
Haemophilus influenzae	6 days
Streptococcus pneumoniae	7 days
Sensitive Enterobacteriaceae	10-14 days

Lyme borreliosis: 50 mg/kg (highest daily dose - 2 g) for adults and children over 12 years of age once a day for 14 days.

Gonorrhea: For the treatment of gonorrhea caused by both penicillinase-forming and non-penicillinase-forming strains, the recommended dose is 250 mg as a single intramuscular dose.

Prevention of postoperative infections, depending on the degree of infectious risk, 1-2 g of ceftriaxone is administered once 30-90 minutes before the start of surgery. During operations on the colon and rectum, the simultaneous (but separate) administration of ceftriaxone and one of the 5-nitroimidazoles has worked well.

Insufficiency of kidney and liver function:

In patients with impaired renal function, provided that liver function is normal, there is no need to reduce the dose of ceftriaxone. Only in case of renal failure in the preterminal stage (creatinine clearance below 10 ml/min) is it necessary that the daily dose of ceftriaxone does not exceed 2 g. In patients with impaired liver function, provided that renal function is preserved, there is also no need to reduce the dose of ceftriaxone.

When severe renal and liver failure are combined, the plasma concentration of ceftriaxone should be regularly determined and its dose adjusted if necessary.

Patients on dialysis do not require additional administration of the drug after dialysis. However, serum ceftriaxone concentrations should be monitored for possible dose adjustments, since the elimination rate of the drug may be reduced in these patients.

Mode of application

For intramuscular administration:

The contents of the bottle are dissolved as follows:

Contents of the bottle	Solvent (water for injection)
1.0 g	3.5 ml

After preparation, each ml of solution contains about 250 mg in terms of ceftriaxone.

If necessary, a more diluted solution can be used. As with other intramuscular injections, ceftriaxone is injected into a relatively large muscle (gluteus); Test aspiration helps avoid inadvertent injection into a blood vessel.

It is recommended to inject no more than 1000 mg of the drug into one muscle. To reduce pain during intramuscular injections, the drug should be administered with a 1% lidocaine solution. Lidocaine solution should not be administered intravenously.

For intravenous administration:

The contents of the bottle are dissolved as follows:

Contents of the bottle	Solvent (water for injection)
1.0 g	10.0 ml

After preparation, each ml of solution contains about 100 mg in terms of ceftriaxone. The solution is administered slowly over 2-4 minutes.

For intravenous infusion, dissolve 2 g of ceftriaxone in 40 ml of sterile water for injection or one of the calcium-free infusion solutions (0.9% sodium chloride solution, 2.5%, 5% or 10% dextrose solution, 5% levulose solution, 6% dextran solution in dextrose). The solution is administered over 30 minutes.

Side effects of Ceftriaxone injections

Non-standard reactions of the body are manifested:

eosinophilia, feverish conditions;
dermatological rashes, obsessive itching;
symptoms of urticaria, swelling;
exudative erythema multiforme;
serum sickness, anaphylactic shock;
attacks of dizziness and headache;
oliguria, flatulence, stomatitis;
vomiting and nausea, glossitis;
dysbacteriosis, pseudomembranous enterocolitis;
leukocytosis, hematuria, spontaneous nosebleeds.

Laboratory diagnostics reveal a decrease in the number of leukocytes, lymphocytes, platelets, etc. With intravenous administration, inflammation of the internal walls of the vessel and painful sensations along their course are observed.

The drug affects the activity of liver transaminases, alkaline phosphatase, and urea concentration. May cause the development of hyperbilirubinemia and glucosuria. Intramuscular injections lead to muscle pain, weakness, skin rashes, obsessive itching, and dizziness.

How to take Ceftriaxone

Ceftriaxone is usually administered by a doctor or nurse. Accepted in the form:

Dropper (intravenous infusion) or injection directly into a vein.
Intramuscular injection.

This medicine is prepared by a doctor, pharmacist or nurse and should not be mixed with or given at the same time as a calcium injection.

Usual dose:

Your doctor will determine the right dose of Ceftriaxone for you. The dose will depend on the severity and type of infection; whether you use any other antibiotics; Your weight and age; How well your kidneys and liver are functioning. The duration of treatment depends on the type of infection.

Use in adults, the elderly and children over 12 years of age and weighing greater than or equal to 50 kilograms:

From 1 to 2 g of ceftriaxone 1 time per day, depending on the severity and type of infection. If you have a severe infection, your doctor will prescribe a higher dose (up to 4 g once a day). If the daily dose exceeds 2 g, then it can be taken once a day or 2 times a day in divided doses.

Use in newborns, infants and children aged 15 days to 12 years weighing less than 50 kilograms:

50-80 mg of ceftriaxone per kilogram of the child’s body weight once a day, depending on the severity and type of infection. If the child has a severe form of infection, the attending physician will prescribe a higher dose from 100 mg per kilogram of the child’s body weight to 4 g once a day. If the daily dose exceeds 2 g, then it can be taken once a day or 2 times a day in divided doses.
Children weighing 50 kg or more should be prescribed the same doses as adults.

Newborns (0-14 days):

20-50 mg of ceftriaxone per kilogram of the child’s body weight once a day. The dose depends on the severity and type of infection.
The maximum daily dose should not be more than 50 mg per kilogram of the child’s body weight.

If you have liver or kidney problems:

You may take a different dose than your usual dose. Your doctor will determine your dose of Ceftriaxone and perform a full examination depending on the severity of your liver or kidney disease.

If you take more Ceftriaxone than recommended:

If you take too much of this medicine , contact your doctor immediately or go to the nearest hospital or emergency room.

If you forget to take Ceftriaxone:

If you forget to take the next dose of the drug, take it as soon as you remember. If it is time for your next dose, do not take the missed dose.

You should not take a double dose of the drug to make up for a missed dose.

If you want to stop taking Ceftriaxone:

If you intend to stop taking Ceftriaxone, you should contact your doctor for advice. If you have any further questions about Ceftriaxone, ask your doctor or pharmacist.