Can ceftriaxone (a cephalosporin antibiotic) be given?

From the Guidelines

Ceftriaxone can be given in the treatment of various bacterial infections, including meningitis, pneumonia, and intra-abdominal infections, with a typical adult dose of 1-2 grams once or twice daily, as recommended by the most recent guidelines 1. The decision to administer ceftriaxone should be based on the specific infection being treated and the susceptibility of the causative organism.

• In the treatment of meningitis, ceftriaxone is recommended as a definitive antibiotic treatment, with a dose of 2 g 12 hourly, as outlined in the UK Joint Specialist Societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults 1.
• The duration of treatment with ceftriaxone depends on the specific infection being treated, ranging from 5 days for Neisseria meningitidis to 10-14 days for Streptococcus pneumoniae, as specified in the guideline 1.
• It is essential to check for allergies to cephalosporins or penicillins before administering ceftriaxone due to potential cross-reactivity.
• Ceftriaxone should not be given simultaneously with calcium-containing solutions or products, especially in neonates, due to the risk of precipitation.
• The drug works by inhibiting bacterial cell wall synthesis and is effective against many gram-positive and gram-negative bacteria, making it useful for various infections.
• Common side effects include diarrhea, rash, and elevated liver enzymes, while more serious reactions like Clostridium difficile-associated diarrhea can occur.
• In patients with severe renal or hepatic impairment, caution is needed, though dose adjustments are generally not required for mild to moderate renal dysfunction.
• Other evidence, such as the guideline on antimicrobial therapy of sexually transmitted diseases in Taiwan 1, also supports the use of ceftriaxone in various infections, including gonococcal urethritis, cervix, rectum, and disseminated gonococcal infection.

From the FDA Drug Label

Ceftriaxone for injection may be administered intravenously or intramuscularly. The answer is yes, ceftriaxone can be given, either intravenously or intramuscularly, as stated in the drug label 2.

• Key administration routes:
  • Intravenous
  • Intramuscular Important considerations:
• Do not use diluents containing calcium to reconstitute or dilute ceftriaxone for injection.
• Ceftriaxone for injection must not be administered simultaneously with calcium-containing IV solutions.

From the Research

Administration of Ceftriaxone

Ceftriaxone can be administered in various clinical settings due to its broad spectrum of activity against Gram-positive and Gram-negative aerobic and anaerobic bacteria. The key points regarding its administration are:

• Ceftriaxone is a third-generation cephalosporin with a long half-life, allowing for once-daily administration 3, 4, 5, 6.
• It can be given intravenously or intramuscularly and has been used to treat a wide range of infections, including urinary tract infections, lower respiratory tract infections, skin and soft tissue infections, and meningitis 3, 4, 5, 6.
• Ceftriaxone has been effective in treating infections due to susceptible organisms, including those caused by multidrug-resistant Gram-negative bacteria 3, 4, 5, 6.

Therapeutic Use

The therapeutic use of ceftriaxone includes:

• Treatment of community-acquired and nosocomial infections, such as pneumonia, meningitis, and spontaneous bacterial peritonitis 7, 6.
• Effective against enteric fever (typhoid and paratyphoid fever) with few adverse effects 7.
• Used as single-dose chemoprophylaxis in various surgical procedures, including coronary artery bypass, biliary tract, vaginal hysterectomy, and prostatic surgery 5.

Efficacy and Safety

• Ceftriaxone has a good tolerability profile, with common adverse events including diarrhea, nausea, vomiting, candidiasis, and rash 6.
• It may cause reversible biliary pseudolithiasis, particularly at higher dosages, but the incidence of true lithiasis is less than 0.1% 6.
• Injection site discomfort or phlebitis can occur after intramuscular or intravenous administration 6.

Key Considerations

• Ceftriaxone's extended half-life allows for less frequent dosing than other antimicrobials, which can result in significant cost savings with proper use 5.
• Its once-daily administration schedule simplifies treatment regimens in both hospital and ambulatory settings 6.
• Clinicians should consider current, local resistance patterns when choosing ceftriaxone as a treatment option 7.