Can 2 grams of Rocephin (ceftriaxone) be used for pyelonephritis?

From the Guidelines

Yes, 2 grams of Rocephin (ceftriaxone) can be used for pyelonephritis.

Key Points

• Ceftriaxone is a recommended empirical choice for patients with pyelonephritis who require intravenous therapy, barring any risk factors for multidrug resistance 1.
• The European Association of Urology guidelines suggest a daily dose of 1-2 g of ceftriaxone for empirical parenteral antimicrobial therapy for uncomplicated pyelonephritis, with a higher dose recommended 1.
• The choice of antimicrobial agent should be based on local resistance patterns and tailored to the individual patient's needs 1.
• Ceftriaxone has been shown to be effective in the treatment of pyelonephritis, with a study demonstrating that initial therapy with intravenous ceftriaxone (1 g for 3 days) was comparable to other treatment regimens 1.

Treatment Considerations

• The dose of ceftriaxone can be administered once daily, with a recommended dose of 1-2 g 1.
• The treatment duration for pyelonephritis typically ranges from 5-14 days, depending on the severity of the infection and the patient's response to treatment 1.
• It is essential to perform urine culture and susceptibility testing to guide antimicrobial therapy and ensure effective treatment 1.

From the FDA Drug Label

The condition appears to be reversible upon discontinuation of ceftriaxone sodium and institution of appropriate management. Ensure adequate hydration in patients receiving CEFTRIAXONE FOR INJECTION Dosage adjustments should not be necessary in patients with hepatic dysfunction; however, in patients with both hepatic dysfunction and significant renal disease, caution should be exercised and the ceftriaxone for injection dosage should not exceed 2 gm daily. Compared to that in healthy adult subjects, the pharmacokinetics of ceftriaxone were only minimally altered in elderly subjects and in patients with renal impairment or hepatic dysfunction (Table 4); therefore, dosage adjustments are not necessary for these patients with ceftriaxone dosages up to 2 g per day Susceptibility interpretive criteria for Enterobacteriaceae are based on a dose of 1 gram IV q 24h. For isolates with intermediate susceptibility, use a dose of 2 grams IV q 24h in patients with normal renal function

Ceftriaxone dosage for pyelonephritis:

• The FDA drug label does not explicitly state the use of 2 grams of Rocephin (ceftriaxone) for pyelonephritis.
• However, it does mention that dosage adjustments are not necessary for patients with ceftriaxone dosages up to 2 g per day, and the susceptibility interpretive criteria for Enterobacteriaceae are based on a dose of 1 gram IV q 24h, with a dose of 2 grams IV q 24h for isolates with intermediate susceptibility in patients with normal renal function.
• Key points:
  • Ensure adequate hydration
  • Dosage should not exceed 2 gm daily in patients with both hepatic dysfunction and significant renal disease
  • No explicit mention of pyelonephritis treatment with 2 grams of ceftriaxone 2 2

From the Research

Dosage and Efficacy of Ceftriaxone for Pyelonephritis

• The study 3 evaluated the clinical efficacy of ceftriaxone administered once daily at a dose of 2g for 5 days in 16 female patients with pyelonephritis, resulting in a 100% efficacy rate in uncomplicated cases and 92% in complicated cases.
• Another study 4 compared the efficacy of ertapenem and ceftriaxone, with ceftriaxone administered at a dose of 2g once daily, and found that ceftriaxone was effective in treating acute pyelonephritis and complicated urinary tract infections.

Comparison of Ceftriaxone with Other Antibiotics

• A study 5 compared the clinical outcomes of patients receiving ceftriaxone (1g IV every 12 hours) with those receiving levofloxacin for the treatment of acute pyelonephritis, and found that ceftriaxone was more effective in terms of microbiological response.
• Another study 6 evaluated the efficacy of a short 7-day treatment with ceftriaxone (1g injection on the first day) followed by cefixime, and found that this regimen was effective in treating acute pyelonephritis in women.

Treatment Duration and Outpatient Treatment

• A study 7 demonstrated that ceftriaxone can be effective in treating acute pyelonephritis in women as an outpatient treatment, with an overall cure rate of 85% 6 weeks after completion of therapy.
• The study 3 also showed that a 5-day course of ceftriaxone was effective in treating pyelonephritis, while another study 4 found that a mean duration of 5.8 days of parenteral ceftriaxone therapy was effective in treating acute pyelonephritis and complicated urinary tract infections.