What precautions should be taken before administering ceftriaxone?

From the Guidelines

Before administering ceftriaxone, it is crucial to assess the patient for any history of hypersensitivity reactions to ceftriaxone, other cephalosporins, penicillins, or beta-lactam antibiotics, as cross-reactivity can occur, as recommended by the European Society of Cardiology guidelines 1. When considering the administration of ceftriaxone, several key precautions must be taken to ensure safe and effective use.

• Obtain a complete medication history to identify potential drug interactions, particularly with calcium-containing products which can form precipitates with ceftriaxone, as noted in the guidelines for the management of infective endocarditis 1.
• Laboratory testing should include baseline renal and hepatic function tests, as dosage adjustments may be necessary in patients with impairment, in line with the recommendations for antibiotic treatment of infective endocarditis due to oral streptococci and Streptococcus bovis group 1.
• A complete blood count is also recommended to monitor for potential hematologic effects.
• Verify the patient is not hyperbilirubinemic, especially in neonates, as ceftriaxone can displace bilirubin from albumin binding sites.
• Ensure the patient is adequately hydrated before administration to reduce the risk of crystalluria.
• When administering intravenously, ceftriaxone should be given slowly over 30 minutes to minimize vein irritation and adverse reactions, as generally recommended for intravenous antibiotic administration.
• For intramuscular injections, reconstitute with appropriate diluents and administer deeply into a large muscle mass. These precautions are essential because ceftriaxone, while generally well-tolerated, can cause serious adverse effects including anaphylaxis, biliary precipitation, and hematologic abnormalities if not administered properly, highlighting the importance of careful patient assessment and monitoring, as emphasized in the guidelines for the management of infective endocarditis 1.

From the FDA Drug Label

Before therapy with ceftriaxone for injection is instituted, careful inquiry should be made to determine whether the patient has had previous hypersensitivity reactions to cephalosporins, penicillins and other beta-lactam agents or other drugs. Ceftriaxone for injection and calcium-containing solutions may be administered sequentially of one another if the infusion lines are thoroughly flushed between infusions with a compatible fluid Ceftriaxone for Injection must not be administered simultaneously with calcium-containing IV solutions, including continuous calcium-containing infusions such as parenteral nutrition via a Y-site Neonates Hyperbilirubinemic neonates, especially prematures, should not be treated with Ceftriaxone for injection Ceftriaxone for injection is contraindicated in premature neonates Ceftriaxone for injection is contraindicated in neonates (≤ 28 days) if they require (or are expected to require) treatment with calcium-containing IV solutions, including continuous calcium- containing infusions such as parenteral nutrition because of the risk of precipitation of ceftriaxone-calcium

Precautions before administering ceftriaxone:

• Check for previous hypersensitivity reactions to cephalosporins, penicillins, and other beta-lactam agents or other drugs 2
• Avoid simultaneous administration with calcium-containing IV solutions 2
• Flush infusion lines with a compatible fluid when administering sequentially with calcium-containing solutions 2
• Avoid use in hyperbilirubinemic neonates, especially prematures, and in neonates requiring calcium-containing IV solutions 2
• Be aware of the risk of Clostridium difficile-associated diarrhea, hemolytic anemia, and other potential adverse reactions 2

From the Research

Precautions Before Administering Ceftriaxone

Before administering ceftriaxone, several precautions should be taken into consideration to minimize the risk of adverse reactions. These include:

• Evaluating the patient's history of allergic reactions to cephalosporins, penicillins, or other beta-lactam antibiotics 3, 4, 5
• Avoiding rapid intravenous injection, as this has been identified as a risk factor for adverse events 3
• Being cautious of unlabelled use of the drug, which can increase the risk of adverse reactions 3
• Considering alternative antibiotics if the patient has a positive history of allergic reaction to cephalosporins, penicillins, or other beta-lactam antibiotics 3, 4, 5

Patient Assessment

It is essential to assess the patient's demographics and previous history of allergic reactions to antibiotics before administering ceftriaxone. This includes:

• Evaluating the patient's system-organ classes, seriousness, and causality of reactions according to the World Health Organization scale 3
• Assessing the preventability of adverse events based on the Schumock questionnaire 3

Special Considerations

Ceftriaxone has been shown to be effective in treating various infections, including those caused by multidrug-resistant Gram-negative bacteria 6, 7. However, it is crucial to use the drug judiciously and follow the recommended dosage and administration guidelines to minimize the risk of adverse reactions. Additionally, ceftriaxone has been used as single-dose chemoprophylaxis in various surgical procedures, and its efficacy and safety have been comparable to multiple-dose cefazolin 7.