From the Guidelines
Using Rocephin (Ceftriaxone) intramuscularly (IM) is a viable option when intravenous (IV) access is not available.
Key Points
- Ceftriaxone can be administered IM in emergency situations when vascular and intraosseous access is unavailable 1.
- The dose of ceftriaxone for IM administration is 50 mg/kg per dose every 24 hours for infants older than 28 days with suspected urinary tract infection (UTI) or no focus identified 2.
- For adults, the dose of ceftriaxone for IM administration is 1 g for certain situations, such as infective endocarditis prophylaxis before a dental procedure 3, 4.
- Intramuscular absorption and distribution of ceftriaxone in severe illness has not been studied, and IM administration should be considered only if timely establishment of vascular access is not possible 1.
- Ceftriaxone is a long-acting parenteral antimicrobial that can be used as an initial dose in the treatment of acute pyelonephritis, especially in areas with low levels of fluoroquinolone resistance 5.
Considerations
- The choice of antimicrobial agent and route of administration should be based on local resistance data, severity of illness, and specific host factors 1, 5.
- Quality improvement initiatives, including defined order sets, can help address delays in antimicrobial initiation and ensure prompt administration of appropriate antimicrobials 1.
From the FDA Drug Label
For the treatment of acute bacterial otitis media, a single intramuscular dose of 50 mg/kg (not to exceed 1 gram) is recommended For the treatment of uncomplicated gonococcal infections, a single intramuscular dose of 250 mg is recommended.
The implications of using Rocephin (Ceftriaxone) intramuscularly (IM) include:
- Contraindications: Ceftriaxone for injection is contraindicated in premature neonates and in neonates (≤ 28 days) if they require treatment with calcium-containing IV solutions.
- Dosage: The recommended dose for acute bacterial otitis media is 50 mg/kg (not to exceed 1 gram) and for uncomplicated gonococcal infections is 250 mg.
- Administration: Ceftriaxone for injection should be injected well within the body of a relatively large muscle, and aspiration helps to avoid unintentional injection into a blood vessel 6. Key points to consider:
- Calcium-containing solutions: 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 7.
- Patient population: The dosage and administration may vary depending on the patient population, such as pediatric or adult patients.
From the Research
Implications of Using Rocephin (Ceftriaxone) Intramuscularly (IM)
The use of Rocephin (Ceftriaxone) intramuscularly (IM) has several implications, including:
- Effective treatment of various infections, such as skin and soft tissue infections, community-acquired respiratory tract infections, and meningitis, as demonstrated in studies 8, 9, 10, 11, 12
- Convenience and cost benefits due to its long serum half-life, which allows for once-daily administration 8, 9, 11
- Reduced risk of complications associated with intravenous administration, such as catheter-related sepsis and phlebitis 10
- Potential for use in outpatient settings, either as part of a step-down regimen or as a parenteral agent in an ambulatory setting 11
- Suitable for use in children, including those with limited intravenous access, as demonstrated in a case study of a child with Haemophilus influenzae type F meningitis 12
Efficacy and Safety
The efficacy and safety of ceftriaxone administered IM have been demonstrated in various studies, including:
- A study comparing the pharmacodynamics of ceftriaxone and cefixime against community-acquired respiratory tract pathogens, which found that ceftriaxone resulted in bactericidal activities and T > MIC for 100% of the dosing period for Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 10
- A review of the use of ceftriaxone in the management of community-acquired and nosocomial infections, which found that ceftriaxone has a good tolerability profile, with the most common events being diarrhea, nausea, vomiting, candidiasis, and rash 11
- A case study of a child with Haemophilus influenzae type F meningitis, which found that daily IM administration of ceftriaxone was an effective treatment option in a patient with good perfusion and limited intravenous access 12
Administration and Dosage
The administration and dosage of ceftriaxone IM vary depending on the specific infection being treated and the patient's age and weight, as demonstrated in studies 8, 9, 10, 11, 12
- A single IM dose of ceftriaxone has been compared with standard therapy for gonorrhoea due to non-penicillinase-producing and penicillinase-producing strains of Neisseria gonorrhoeae and shown to be highly effective 9
- Reduced-dose ceftriaxone given IM seems to be a viable alternative to ceftriaxone IV if the pathogen, susceptibility, and infection site are known 10