Can ceftriaxone be administered via a Nasogastric Tube (NGT)?

Ceftriaxone Administration via Nasogastric Tube

Ceftriaxone should NOT be administered via nasogastric tube (NGT) as it is only available in injectable formulations for intravenous or intramuscular administration.

Rationale for Recommendation

Available Formulations and Administration Routes

• Ceftriaxone is a third-generation cephalosporin antibiotic that is only available as a parenteral formulation 1, 2
• It must be administered via intravenous (IV) or intramuscular (IM) routes 1, 3
• There is no oral or liquid formulation of ceftriaxone available for enteral administration

Medication Administration via NGT - General Guidelines

The ESPEN guidelines on home enteral nutrition provide clear recommendations regarding medication administration through enteral tubes:

1. The necessity and appropriateness for any drug to be administered through an enteral tube should be confirmed 4
2. Potential interactions between the drug, enteral formula, and the tube material must be considered 4
3. The site of drug delivery (gastric vs. post-pyloric) can affect drug efficacy 4

Specific Considerations for Ceftriaxone

• Ceftriaxone has a long half-life (6-8 hours) which allows for once-daily dosing via IV or IM routes 2, 3
• The pharmacokinetic properties of ceftriaxone have been established for parenteral administration only 2
• No studies have evaluated the bioavailability or efficacy of ceftriaxone when administered enterally 5

Alternative Approaches

For patients requiring both NGT feeding and ceftriaxone therapy:

1. Maintain parenteral administration: Continue administering ceftriaxone via IV or IM routes as intended 1, 3

   • IM administration can be used for outpatient therapy when IV access is not available 6
   • Once-daily dosing (due to long half-life) minimizes the number of injections required 3

2. Consider alternative antibiotics: If enteral administration is absolutely necessary, consult with infectious disease specialists to select an appropriate oral antibiotic with similar spectrum that is available in a formulation suitable for NGT administration 5

Important Considerations for Medication Administration via NGT

When administering medications that are appropriate for NGT use:

• Drugs should be administered individually through the enteral feeding tube 4
• The tube should be flushed with 30 mL of water before, between, and after each drug 4
• Medications should not be mixed prior to administration due to risk of drug-drug interactions 4
• Special attention should be paid to the compatibility of the medication with the enteral formula 4

Conclusion

Ceftriaxone cannot be administered via NGT as it is only available in injectable formulations for parenteral use. Attempting to administer ceftriaxone via NGT would be inappropriate and potentially harmful, as its bioavailability, safety, and efficacy via this route have not been established. Parenteral administration (IV or IM) remains the only appropriate route for ceftriaxone therapy.