Prevention of secondary case ofHaemophilus influenzae
type b disease
▶BY INTRAVENOUS INFUSION
▶Child 1 month–11 years: 50 mg/kg daily (max. per dose
1 g) for 2 days
▶BY INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS
INJECTION, OR BY INTRAVENOUS INFUSION
▶Child 12–17 years: 1 g daily for 2 days
Acute otitis media
▶BY DEEP INTRAMUSCULAR INJECTION
▶Child 1 month–11 years (body-weight up to
50 kg): 50 mg/kg (max. per dose 2 g) for 1 dose, dose
can be given for 3 days if severely ill or previous
therapy failed
▶Child 9–11 years (body-weight 50 kg and above): 1 – 2 gfor
1 dose, dose can be given for 3 days if severely ill or
previous therapy failed
▶Child 12–17 years: 1 – 2 gfor 1 dose, dose can be given for
3 days if severely ill or previous therapy failedlUNLICENSED USEgNot licensed for prophylaxis of
Haemophilus influenzaetype b disease.lNot licensed for
prophylaxis of meningococcal meningitis.gNot
licensed for congenital gonococcal conjunctivitis. Not
licensed for use in children under 12 years of age for
uncomplicated gonorrhoea. Not licensed for use in
children for pelvic inflammatory disease.l
lCONTRA-INDICATIONSConcomitant treatment with
intravenous calcium (including total parenteral nutrition
containing calcium) in premature and full-term
neonates—risk of precipitation in urine and lungs (fatal
reactions).full-term neonates with jaundice,
hypoalbuminaemia, acidosis, unconjugated
hyperbilirubinaemia, or impaired bilirubin binding—risk of
developing bilirubin encephalopathy.premature neonates
less than 41 weeks corrected gestational age
lCAUTIONSHistory of hypercalciuria.history of kidney
stones.use with caution in neonates
lINTERACTIONS→Appendix 1 : cephalosporins
lSIDE-EFFECTS
▶UncommonAnaemia.coagulation disorder.
granulocytopenia
▶Rare or very rareBronchospasm.glycosuria.haematuria.
oedema
▶Frequency not knownAcute generalised exanthematous
pustulosis (AGEP).cholelithiasis.hypersensitivity.
kernicterus (in neonates).nephrolithiasis.oral disorders.
pancreatitis.seizure.vertigo
SIDE-EFFECTS, FURTHER INFORMATIONPrecipitates of
calcium ceftriaxone can occur in the gall bladder and urine
(particularly in very young, dehydrated or those who are
immobilised)—consider discontinuation if symptomatic.
lPREGNANCYManufacturer advises use only if benefit
outweighs risk—limited data available but not known to be
harmful inanimalstudies.gSpecialist sources indicate
suitable for use in pregnancy.k
lBREAST FEEDINGgSpecialist sources advise
ceftriaxone is compatible with breastfeeding—present in
milk in low concentration but limited effects to breast-fed
infant.k
lRENAL IMPAIRMENT
Dose adjustmentsManufacturer advises reduce dose and
monitor efficacy in patients with severe renal impairment
in combination with hepatic impairment—no information
available.
Manufacturer advises reduce dose if estimated
glomerulerfiltration rate less than 10 mL/minute/ 1. 73 m^2
max. 50 mg/kg daily or max. 2 g daily).lMONITORING REQUIREMENTSManufacturer advises to
monitor full blood count regularly during prolonged
treatment.
lDIRECTIONS FOR ADMINISTRATION
▶With intramuscular use or intravenous useTwice daily dosing
may be considered for doses greater than 2 g daily.
▶With intravenous useForintravenous infusion(preferred
route), dilute reconstituted solution with Glucose 5 %(or
10 % in neonates)orSodium Chloride 0. 9 %; give over at
least 30 minutes ( 60 minutes in neonates—may displace
bilirubin from serum albumin). Not to be given
simultaneously with parenteral nutrition or infusionfluids
containing calcium, even by different infusion lines; in
children, may be infused sequentially with infusionfluids
containing calcium if infusion lines at different sites are
used, or if the infusion lines are replaced or thoroughly
flushed between infusions with Sodium Chloride 0. 9 %to
avoid precipitation—consult product literature.
Displacement value may be significant, consult local
guidelines. Forintravenous injection, give over 5 minutes.
▶With intramuscular useForintramuscular injection, may be
mixed with 1 % Lidocaine Hydrochloride Injection to
reduce pain at intramuscular injection site. Intramuscular
injection should only be considered when the intravenous
route is not possible or less appropriate. If administered by
intramuscular injection, the lower end of the dose range
should be used for the shortest time possible; volume
depends on the age and size of the child, but doses over 1 g
must be divided between more than one site.
Displacement value may be significant, consult local
guidelines. The maximum single intramuscular dose is 2 g,
doses greater than 2 g must be given in divided dosesorby
intravenous administration (see above).lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: infusion
Powder for solution for injection
ELECTROLYTES:May contain Sodium
▶Ceftriaxone (Non-proprietary)
Ceftriaxone (as Ceftriaxone sodium) 250 mgCeftriaxone 250 mg
powder for solution for injection vials| 1 vialP£ 2. 30 DT = £ 2. 40
Ceftriaxone (as Ceftriaxone sodium) 1 gramCeftriaxone 1 g powder
for solution for injection vials| 1 vialPsDT = £ 9. 58 |
10 vialP£ 91. 50 – £ 95. 80
Ceftriaxone (as Ceftriaxone sodium) 2 gramCeftriaxone 2 g
powder for solution for injection vials| 1 vialP£ 18. 30 DT =
£ 19. 18 | 10 vialP£ 191. 80
Ceftriaxone 2 g powder for solution for infusion vials| 1 vialP
£ 19. 18 DT = £ 19. 18
▶Rocephin(Roche Products Ltd)
Ceftriaxone (as Ceftriaxone sodium) 250 mgRocephin 250 mg
powder for solution for injection vials| 1 vialP£ 2. 40 DT = £ 2. 40
Ceftriaxone (as Ceftriaxone sodium) 1 gramRocephin 1 g powder
for solution for injection vials| 1 vialP£ 9. 58 DT = £ 9. 58
Ceftriaxone (as Ceftriaxone sodium) 2 gramRocephin 2 g powder
for solution for injection vials| 1 vialP£ 19. 18 DT = £ 19. 18324 Bacterial infection BNFC 2018 – 2019
Infection5