Ceftriaxone should be injected strictly as prescribed by the doctor, on average the course is 7-10 days, but in severe cases may be extended up to two weeks. A minimum duration (5 days) is recommended for mild flow illness and during stepwise therapy, that is, when switching from Ceftriaxone to tablets. Longer treatment is needed for streptococcal infections, chronic inflammation, moderate and severe course diseases.

Adults are administered 1-2 g once a day, children 20-80 mg per 1 kg of body weight. Diluted with 1% lidocaine solution. For meningitis it can be prescribed maximum dose 4 g for an adult and 100 mg/kg for a child for 2-3 days before determining the pathogen; based on the results of the analysis, the course of injections is set for 5-7 days.

On average, ceftriaxone needs to be injected for 7-10 days. In each case, the doctor determines the individual duration of the course. It will depend on:

• severity of the disease - with a mild infection, 5-7 days may be enough, with medium degree severity will need 10, and severe forms will require administration for about 2 weeks;
• witticisms inflammatory reaction– in acute forms the course is shorter;
• state of the immune system - if immunity decreases, treatment takes longer;
• pathogen - for example, for acute uncomplicated gonorrhea, the antibiotic is administered only 1 time, and for streptococcal infection it should be injected for at least 10 days;
• use of other drugs - when switching to antibiotic tablets according to the step-down therapy scheme, you can limit yourself to a minimum course of 5 days;
• achieved result - when there is no improvement in the condition within 3 days, it is often necessary to change the drug or add a second one.

In the vast majority of cases, the doctor cannot know in advance how many injections the patient will need, since he evaluates the reaction to the drug based on objective data:

• reduction of symptoms;
• decrease in temperature and other signs of microbial intoxication: headache, appetite, nausea, general weakness;
• examination (for example, a decrease in wheezing in the lungs with pneumonia or pain when palpating the abdomen with inflammation in the abdominal cavity);
• results of blood tests, urine tests and instrumental diagnostics.

The duration of treatment is approximately determined by reducing the temperature (in case of acute inflammation); after its normalization, injections should be given for another 2-3 days. If the disease has a chronic course with frequent exacerbations, then it is important to obtain laboratory confirmation of the destruction of the pathogen (culture results, blood tests).

How to breed

For intramuscular injection Ceftriaxone must be diluted with 1% lidocaine solution. The addition of an anesthetic is necessary due to the severe pain of antibiotic injections. To prepare the solvent, add 2 ml of 2% Lidocaine and 2 ml of water for injection into a 5 ml syringe.

The entire volume of the resulting solution is injected through the rubber cap into the Ceftriaxone vial, without removing the needle, shake it until completely dissolved. Then the antibiotic and solvent are drawn into a syringe and an injection is given.

The use of Novocaine is not recommended, as it increases the likelihood allergic reactions. If the patient is found to be intolerant to Lidocaine, then take only water for injection in the amount of 3.8 ml. It will also be needed for intravenous injection, because when Lidocaine is injected into a vein, the heart rhythm is disrupted. For 1 g of the drug, 10 ml of solvent is needed for injection into a vein.

Ceftriaxone is also used for IV drips in hospital settings. It is placed on 0.9% sodium chloride (isotonic, or saline), 5% glucose, 6% Voluven. One infusion will require 40-50 ml of solvent and 2 g of antibiotic. It is prohibited to combine Ceftriaxone with solutions containing calcium.

Is it possible during pregnancy?

It has been established that it penetrates the placenta from mother to fetus. There is no confirmed data yet that the antibiotic is completely harmless to the child. Doctors can only rely on animal studies that have not shown fetal abnormalities or worsening pregnancy.

How much can you inject for the elderly?

Ceftriaxone for the elderly is used according to the same rules as for adult patients, therefore, how much it will need to be injected is determined by the dynamics of the disease. After 24 hours normal temperature Most often it is prescribed for another 2-3 days.

It is important to consider that the absence of fever in a patient after 50 years of age is possible from the very beginning of the disease, which does not exclude the presence of an infectious process. Therefore, when prescribing a course of treatment, they are usually guided by test results.

The maximum duration of antibiotic therapy in old age has not been established, but it is imperative to monitor the functioning of the liver and kidneys and drug tolerance. If complications occur or there is a threat of their development, the doctor may recommend changing the medication or prescribe medications that have a beneficial effect. protective effect on the:

• immunity – Derinat, Polyoxidonium;
• kidneys – Canephron, Nephrosten;
• liver – Essentiale, Gepabene;
• intestines – Enterol, Lactobacterin, Linex;
• metabolic processes - Alphabet in the cold season, Supradin Immuno Forte;
• development of fungal infection - Fluconazole.

Watch this video for instructions on how to use Ceftriaxone:

How many days to inject Ceftriaxone for bronchitis in an adult, dosage

For otitis media

For acute otitis media, Ceftriaxone is administered at a dose of 1-2 g for about 7 days; it is indicated for severe cases, temperatures over 38 degrees and severe pain. A doctor can prescribe it for:

• recurrent course;
• discharge of pus or detection of increased indicators of acute inflammation in the blood (C-reactive protein, leukocytes, ESR);
• threat of infection spread.

For sinusitis

The standard treatment regimen for sinusitis is 1-2 g of Ceftriaxone once a day for 7 days. Inflammation of the maxillary sinus, like other sinusitis (frontal sinusitis, ethmoiditis), can be of viral or bacterial origin, and antibiotics are indicated only in the second case. Signs for prescribing the drug include:

• start with a temperature above 38.5 degrees;
• purulent discharge;
• facial pain, bloating, lasting at least 3 days;
• deterioration of condition after acute respiratory viral infection (second wave of the disease);
• inflammatory changes in the blood.

For cystitis

For meningitis

Ceftriaxone is combined with one of the most effective antibacterial agents for inflammation of the meninges. The maximum dose prescribed is 4 g for an adult and 80-100 mg per 1 kg of weight until the pathogen is determined. Then, if sensitivity is good, the dose can be reduced and a course of treatment established:

• meningococcal infection – 5 days;
• hemophilus influenzae is inoculated - 6 days;
• streptococcal meningitis – 7 days.

Interval between Ceftriaxone injections

Ceftriaxone injections are given at intervals of 24 hours. It is extremely important to accurately observe the injection time, as the success of the treatment depends on it. If you miss or take a break of more than a day, the concentration of antibiotic in the blood required to destroy bacteria decreases. At the same time, microbes acquire the ability to resist the medication, which will require a further increase in dose or lengthening of the course, or a change in the antibacterial agent.

It has been established that repeated administration of the same antibiotic over 3 months is ineffective, so a break of at least 100 days is needed between courses of Ceftriaxone injection. The doctor may prescribe Azithromycin or Ciprofloxacin instead. Other cephalosporins or penicillins will be used less frequently, as there is cross-resistance between them and Ceftriaxone.

How long can a child be injected with Ceftriaxone?

Ceftriaxone can be injected into a child for an average of 7-10 days, the duration of the course mainly depends on the diagnosis (see table). The daily dose is calculated per 1 kg of weight - 20-50 mg, with severe inflammation it increases to 80-100 mg/kg.

Diagnosis	How many days should children be injected?
Bronchitis with frequent exacerbations
Pneumonia
Acute sinusitis
Acute otitis media	7, but if the child attends kindergarten, or is under 2 years old, there is purulent discharge, then 10
Angina
Acute inflammation of the bladder
Pyelonephritis	10 with switching to tablets or 14 with administration of Ceftriaxone alone

Precautions when taking antibiotic injections

Ceftriaxone is not considered a dangerous drug, since in most patients, antibiotic injections are well tolerated and do not cause complications. However, even cases of death have been reported with its use due to:

• anaphylactic reaction (extremely rapid development of allergies), therefore, if redness, itching of the skin, swelling, or difficulty breathing appear, you should immediately stop injections and consult a doctor;
• autoimmune anemia (antibodies are formed that destroy red blood cells) - if a decrease in red blood cells and hemoglobin is detected, it is necessary to find out whether this is related to the antibiotic; Ceftriaxone cannot be administered before the examination;
• due to colitis (pseudomembranous) and uncontrolled proliferation of bacteria (clostridia), with increased frequency of stools and painful urges, you should not try to normalize stools on your own; a doctor’s examination and tests are necessary;
• deposition of Ceftriaxone and calcium salts in the lungs and kidneys, especially in children under 3 years of age.

To increase the effectiveness of therapy and prevent complications, it is recommended:

• drink at least 1.5 liters of water, turn on sufficient quantity protein in the diet (fish, chicken, fermented milk drinks, cottage cheese);
• in case of increased bleeding, vitamin K (Vikasol) is administered;
• At least once every 10 days, monitor blood tests - coagulation, liver, kidney tests.

Ceftriaxone should always be prescribed by a doctor, and he will monitor the treatment, order examinations, and determine the risks of adverse reactions.

Watch this video about why you should not dilute Ceftriaxone with Lidocaine and what risks this poses to the patient:

Possible complications from injections

When Ceftriaxone is administered, local complications are possible:

• pain, burning sensation when pricked;
• lump in the buttock;
• phlebitis.

To the most frequent general reactions relate:

• addition of a fungal infection (thrush);
• allergy;
• abdominal pain, diarrhea;
• precipitation of salts in the bile and urinary tracts;
• changes in the blood - decrease in red blood cells, platelets, leukocytes.

Efficacy of the drug

Ceftriaxone has proven its effectiveness (about 74% successful treatment) for such diseases:

• bronchi and lungs - bronchitis, pneumonia, abscess, accumulation of pus in the pleural cavity;
• ear, throat, nose – sore throat, sinusitis, acute;
• infections of the skin and soft tissues - pyoderma, phlegmon, abscess, carbuncle;
• inflammation urinary tract– pyelonephritis, cystitis;
• infectious process in the abdominal cavity - peritonitis, cholangitis, pus in gallbladder(empyema), pancreatitis;
• pelvic diseases – endometritis;
• bacterial meningitis;
• damage to the heart valves – bacterial endocarditis;
• gonorrhea, syphilis;
• sepsis (blood poisoning);
• Lyme disease (); We recommend reading about. From the article you will learn when Ceftriaxone is prescribed for cats, how to properly dose and inject a cat, as well as how much to inject the drug and its analogues.

  And more about how and when to inject Ceftriaxone into a dog.

  Ceftriaxone is used for 5 to 14 days, most often the course of treatment is 1-1.5 weeks. In each case, the duration of therapy is determined by the doctor, monitors the treatment and identifies the risks of side effects.

Ceftriaxone is a 3rd generation cephalosporin antibiotic. It has a broad bactericidal effect and is active against aerobic and anaerobic gram-negative and gram-positive microorganisms. The drug is intended for parenteral use only. Instructions for use recommend giving injections for infectious pathologies.

Composition and release form

Ceftriaxone is produced in the form of a powder for the preparation of a solution in glass bottles of 0.5 g, 1 or 2 g, containing the active substance of the same name - in a volume of 0.5 g, 1 or 2 g.

Pharmacological properties

The instructions for use indicate that Ceftriaxone is a semi-synthetic antibiotic belonging to the group of 3rd generation cephalosporins. Its bactericidal activity is achieved by suppressing the synthesis of cell membranes.

This drug is resistant to beta-lactamases. The product exhibits a broad bactericidal effect. It is active against aerobic gram-negative and gram-positive microorganisms, as well as anaerobic microorganisms.

After intramuscular administration, Ceftriaxone is quickly and completely absorbed into the systemic circulation. Penetrates well into tissues and fluids of the body: respiratory tract, bones, joints, urinary tract, skin, subcutaneous tissue and abdominal organs. In case of inflammation of the meningeal membranes, it penetrates well into the cerebrospinal fluid.

What does Ceftriaxone help with?

According to the instructions, the medicine is prescribed for infectious and inflammatory diseases:

• ear, throat, nose;
• sepsis;
• gonorrhea;
• skin and soft tissues;
• genitals;
• disseminated Lyme borreliosis in early and late stages;
• respiratory tract;
• meningitis;
• urinary tract and kidneys;
• abdominal organs (infections of the biliary tract and gastrointestinal tract, peritonitis);
• joints and bones;
• in patients with weakened immune systems;
• pelvic organs;
• wound infections.

Why is Ceftriaxone still prescribed? The indication for use is the prevention of infections after operations.

Instructions for use

Ceftriaxone is administered intramuscularly and intravenously (stream or drip).

For adults and children over 12 years of age, the dose is 1-2 g once a day or 0.5-1 g every 12 hours. Maximum daily dose— 4 g.

For infants and children under 12 years of age, the daily dose is 20-80 mg/kg. In children weighing 50 kg or more, adult doses are used.

For the prevention of postoperative infectious complications administered once in a dose of 1-2 g (depending on the degree of risk of infection) 30-90 minutes before the start of surgery. During operations on the colon and rectum, additional administration of a drug from the group of 5-nitroimidazoles is recommended.

In patients with impaired renal function, dose adjustment is required only when renal failure severe (creatinine clearance less than 10 ml/min), in this case the daily dose of ceftriaxone should not exceed 2 g.

Ceftriaxone for children with skin and soft tissue infections is prescribed in a daily dose of 50-75 mg/kg body weight once a day or 25-37.5 mg/kg every 12 hours, but not more than 2 g per day. For severe infections of other localization - at a dose of 25-37.5 mg/kg every 12 hours, but not more than 2 g per day.

A dose of more than 50 mg/kg body weight should be administered as an intravenous infusion over 30 minutes. The duration of treatment depends on the nature and severity of the disease.

For the treatment of gonorrhea, the dose is 250 mg IM, once.

For newborns (up to 2 weeks of age) the dose is 20-50 mg/kg per day.

For bacterial meningitis in infants and children younger age the dose is 100 mg/kg once a day. The maximum daily dose is 4 g. The duration of therapy depends on the type of pathogen and can range from 4 days for meningitis caused by Neisseria meningitidis to 10-14 days for meningitis caused by sensitive strains of Enterobacteriaceae.

For otitis media, the drug is administered intramuscularly at a dose of 50 mg/kg body weight, but not more than 1 g.

Rules for the preparation and administration of injection solutions (how to dilute the drug)

• Injection solutions should be prepared immediately before use.
• To prepare a solution for intramuscular injection, 500 mg of the drug is dissolved in 2 ml, and 1 g of the drug is dissolved in 3.5 ml of a 1% lidocaine solution. It is recommended to administer no more than 1 g per gluteal muscle.
• Dilution for intramuscular use can also be done using water for injection. The effect is the same, only the injection will be more painful.
• To prepare a solution for intravenous injection, 500 mg of the drug is dissolved in 5 ml, and 1 g of the drug is dissolved in 10 ml sterile water for injection. The injection solution is administered intravenously slowly over 2-4 minutes.
• To prepare a solution for intravenous infusion, 2 g of the drug is dissolved in 40 ml of one of the following calcium-free solutions: 0.9% sodium chloride solution, 5-10% dextrose (glucose) solution, 5% levulose solution. The drug at a dose of 50 mg/kg or more should be administered intravenously over 30 minutes.
• Freshly prepared solutions of ceftriaxone are physically and chemically stable for 6 hours at room temperature.

Contraindications

According to the instructions, Ceftriaxone is not prescribed in case of known hypersensitivity to cephalosporin antibiotics or auxiliary components of the drug.

Relative contraindications:

• the neonatal period if the child has hyperbilirubinemia;
• prematurity;
• renal or liver failure;
• lactation;
• pregnancy;
• enteritis, UC or colitis associated with the use of antibacterial agents.

Side effect

The drug can cause a number of adverse reactions in the body:

• anaphylactic shock;
• hypercreatininemia;
• flatulence;
• stomatitis, glossitis;
• taste disturbance;
• dysbacteriosis;
• oliguria, renal dysfunction;
• abdominal pain;
• diarrhea;
• increased urea content;
• glucosuria;
• nosebleeds;
• urticaria, rash, itching;
• nausea, vomiting;
• hematuria;
• bronchospasm;
• headache, dizziness;
• anemia, leukopenia, leukocytosis, lymphopenia, neutropenia, granulocytopenia, thrombocytopenia.

During pregnancy and breastfeeding

The drug is contraindicated in the first trimester of pregnancy. If it is necessary to prescribe to a nursing woman, the child should be switched to formula.

Dosage form:  P powder for preparing a solution for intravenous and intramuscular administration. Compound: For 1 bottle:

Ceftriaxone 250 mg

Active substance: ceftriaxone sodium trisesquihydrate - 298 mg (in terms of ceftriaxone - 250 mg);

Ceftriaxone 500 mg

Active substance: ceftriaxone sodium trisesquihydrate - 596 mg (in terms of ceftriaxone - 500 mg);

Ceftriaxone 1000 mg

Active substance: ceftriaxone sodium trisesquihydrate - 1193 mg (in terms of ceftriaxone - 1000 mg).

Description:

An almost white to yellowish or yellowish-orange crystalline powder, slightly hygroscopic.

Pharmacotherapeutic group:antibiotic-cephalosporin ATX:  

J.01.D.D.04 Ceftriaxone

Pharmacodynamics:

Ceftriaxone is a third generation cephalosporin antibiotic for parenteral use. The bactericidal activity of ceftriaxone is due to the suppression of the synthesis of cell membranes. has wide range actions against gram-negative and gram-positive microorganisms. It is highly resistant to most beta-lactamases (both penicillinases and cephalosporinases) produced by gram-positive and gram-negative bacteria.

Ceftriaxone is usually active against the following microorganisms:

Gram-positive aerobes

Staphylococcusaureus (methicillin-sensitive), coagulase-negative staphylococci, Streptococcuspyogenes (b-hemolytic, groups A), Streptococcusagalactiae (b-hemolytic, group B), b-hemolytic streptococci (groups neither A nor B), Streptococcusviridans, Streptococcuspneumoniae.

Note. Methicillin-resistant Staphylococcus spp. resistant to cephalosporins, including ceftriaxone. Usually, Enterococcus faecalis, Enterococcus faecium and Listeria monocytogenes also stable.

Gram-negative aerobes

Acinetobacter lwoffii, Acinetobacter anitratus( mainly, A. baumannii)*,Aeromonas hydrophila, Alcaligenes faecalis, Alcaligenes odorans, alkali gene-like bacteria, Borrelia burgdorferi, Capnocytophaga spp., Citrobacter diversu s (including C. amalonaticus), Citrobacter freundii *, Escherichia coli, Enterobacter aerogenes *, Enterobacter cloacae, Enterobacter spp.(others)*, Haemophilus ducreyi, Haemophilus influenzae, Haemophilus parainfluenzae, Hafnia alvei, Klebsiella oxytoca, Klebsiella pneumoniae **, Moraxella catarrhalis(previously called Branhamella catarrhalis), Moraxella osloensis, Moraxella spp.. (others), Morganella morganii, Neisseria gonorrhoeae, Neisseria meningitidis, Pasteurella multocida, Plesiomonas shigelloides, Proteus mirabilis, Proteus penneri*, Proteus vulgaris*, Pseudomonas fluorescens*, Pseudomonas spp.(others), Providencia rettgeri*, Providencia spp.(others), Salmonella typhi, Salmonella spp.(non-typhoid), Serratia marcescens*, Serratia spp. (others)*, Shigella spp., Vibrio spp., Yersinia enterocolitica, Yersinia spp.(others).

* - Some isolates of these species are resistant to ceftriaxone, mainly due to the formation of chromosomally encoded β-lactamases.

** - Some isolates of these species are resistant due to the formation of a number of plasma-mediated β-lactamases.

Note. Many strains of the above microorganisms, multiresistant to other antibiotics, such as aminopenicillins and ureidopenicillins, first and second generation cephalosporins and aminoglycosides, are sensitive to ceftriaxone.

Treponemapallidum sensitive to ceftriaxone invitro and in animal experiments. Clinical trials show that it has good effectiveness against primary and secondary syphilis. With very few exceptions, clinical isolates R. aeruginosa resistant to ceftriaxone.

Anaerobes

Bacteroides spp.(bile sensitive)*, Clostridium spp. ( except S. difficile), Fusobacterium nucleatum, Fusobacterium spp. (others), Gaffkya anaerobica(previously called Peptococcus), Peptostreptococcus spp.

*- Some isolates of these species are resistant to ceftriaxone due to the formation of β-lactamases.

Note. Many β-lactamase-forming strains are resistant to ceftriaxone.Bacteroides spp. (in particularB. fragilis). Stable andClostridium difficile.

Susceptibility to ceftriaxone can be determined by the disk diffusion method or by the serial dilution method on agar or broth, using a standard procedure similar to that recommended by the Institute of Clinical and laboratory standards(ICLS). ICLS has established the following criteria for assessing test results for ceftriaxone:

	Sensitive	Moderately sensitive	Stable
Dilution method
Overwhelming concentration, mg/l		16-32
Disc method (disc with 30 mcg ceftriaxone)
Diameter of growth retardation zone, mm		20-14

For determination, you should take disks with ceftriaxone, because in researchin vitrohas been shown to be active against individual strains that exhibit resistance when using discs intended for the entire group of cephalosporins.

Instead of ICLS standards, other well-standardized standards can be used to determine the sensitivity of microorganisms, for example, the German Institute for Standardization DIN (Deutsches Institut fur Normung) and international recommendations ICS (International Collaborative Study), which allow adequate interpretation of the state of sensitivity.

Pharmacokinetics:

The pharmacokinetics of ceftriaxone is nonlinear. All major pharmacokinetic parameters based on total drug concentrations, with the exception of half-life, are dose dependent and increase less than dose proportionally.

Suction

The maximum concentration in blood plasma after a single intramuscular injection of 1 g of the drug is about 81 mg/l and is achieved within 2-3 hours after administration. The areas under the plasma concentration-time curve after intravenous and intramuscular administration are the same. This means that the bioavailability of ceftriaxone after intramuscular administration is 100%.

After intravenous bolus administration of 500 mg and 1 g of ceftriaxone, the average maximum concentration in blood plasma was 120 mg/ml and 200 mg/l, respectively. Following intravenous infusion of 500 mg, 1 g, and 2 g of ceftriaxone, plasma drug concentrations were approximately 80, 150, and 250 mg/L, respectively. After intramuscular injection, the average maximum concentration of ceftriaxone in the blood plasma is approximately two times lower than after intravenous administration equivalent dose of the drug.

Distribution

The volume of distribution of ceftriaxone is 7-12 liters. After administration in a dose of 1-2 g, it penetrates well into tissues and body fluids. For more than 24 hours, its concentrations far exceed the minimum inhibitory concentrations for most infectious agents (including in the lungs, heart, biliary tract, liver, tonsils, middle ear and nasal mucosa, bones, as well as spinal, pleural and synovial fluids and secret prostate gland).

Ceftriaxone quickly diffuses into the cerebrospinal fluid, where it retains a bactericidal effect against microorganisms sensitive to it for 24 hours.

Ceftriaxone binds reversibly to albumin. The degree of binding decreases with increasing concentration: when the drug concentration in the blood plasma is less than 100 mg/l, the binding of ceftriaxone is 95%, and at a concentration of 300 mg/l it is only 85%. Due to the lower concentration of albumin in tissue fluid, the proportion of free ceftriaxone in it is higher than in plasma.

Penetration into individual tissues

Ceftriaxone penetrates the meninges, to the greatest extent when they are inflamed. The mean maximum concentration of ceftriaxone in the cerebrospinal fluid reaches 25% of the plasma concentration of ceftriaxone in patients with bacterial meningitis, and only 2% of the plasma concentration in patients with non-inflamed meninges. The maximum concentration of ceftriaxone in the cerebrospinal fluid is achieved 4-6 hours after its intravenous administration. passes through the placental barrier and enters the body in small concentrations breast milk.

Metabolism

Ceftriaxone is not subject to systemic metabolism, but is converted into inactive metabolites under the influence of intestinal flora.

Removal

The total plasma clearance of ceftriaxone is 10-22 ml/min. Renal clearance is 5-12 ml/min. 50-60% of ceftriaxone is excreted unchanged through the kidneys, and 40-50% is excreted unchanged through the intestines. The half-life of ceftriaxone is approximately 8 hours in adults.

Pharmacokinetics in special clinical cases

U newborn children The half-life of ceftriaxone is increased compared to other age groups. In the first 14 days of life, the concentration of free ceftriaxone in the blood plasma can be further increased due to the low glomerular filtration and the characteristics of the drug’s binding to blood plasma proteins.

U pediatric patients under 12 years of age The half-life is shorter than in neonates and adults.

The values ​​of plasma clearance and volume of distribution of total ceftriaxone are higher in newborns, infants and children under 12 years of age compared to adult patients.

In patients With impaired renal or liver function The pharmacokinetics of ceftriaxone changes slightly, with only a slight increase in the half-life (less than 2 times) even in patients with severe renal failure.

If only renal function is impaired, excretion through bile increases; if only liver function is impaired, excretion through the kidneys increases.

U patients over 75 years old The half-life is on average two to three times longer than in adult patients.

Indications:

Infections caused by pathogens sensitive to the drug: sepsis; meningitis; disseminated Lyme disease (II and Stage III diseases); infections of the upper and lower respiratory tract, especially pneumonia, and infections of the ENT organs; infections of the abdominal organs (peritonitis, infections of the biliary tract and gastrointestinal tract); infections of bones, joints, soft tissues, skin, as well as wound infections; kidney and urinary tract infections; genital infections, including gonorrhea; infections in immunocompromised patients.

Perioperative prevention of infections.

Contraindications:

Hypersensitivity

Hypersensitivity to ceftriaxone and any other component of the drug.

Hypersensitivity to cephalosporins.

History of severe hypersensitivity reactions (eg, anaphylactic reactions) to other β-lactam antibiotics (penicillins, monobactams and carbapenems).

Premature babies

For premature infants up to 41 weeks of age inclusive (combined gestational and chronological age), the use of ceftriaxone is contraindicated.

Term newborns (≤ 28 days of age)

Hyperbilirubinemia, jaundice or acidosis, hypoalbuminemia in newborns (studies invitro have shown that it can displace bilirubin from binding to serum albumin, increasing the risk of developing bilirubin encephalopathy in such patients).

Intravenous administration of calcium-containing solutions to newborns.

Neonates (≤ 28 days) who are already prescribed or are to be treated with intravenous calcium-containing solutions, including continuous calcium-containing infusions, such as parenteral nutrition, due to the risk of precipitates of ceftriaxone calcium salts (see Dosage and Administration and Interactions). with other drugs"). Isolated fatal cases of the formation of precipitates in the lungs and kidneys in newborns who received calcium-containing solutions have been described. In some cases, a single venous access was used, and the formation of precipitates was observed directly in the intravenous system, and at least one case of death was described with different venous accesses and different times of administration of ceftriaxone and calcium-containing solutions. Similar cases were observed only in newborns (see subsection "Post-registration surveillance").

Lidocaine

Before performing an intramuscular injection of ceftriaxone using lidocaine, it is necessary to exclude the presence of contraindications to lidocaine. Contraindications to the use of lidocaine are given in the instructions for medical use lidocaine. Ceftriaxone solutions containing , should not be administered intravenously.

Carefully:

Breastfeeding period; history of mild hypersensitivity reactions to other β-lactam antibiotics (penicillins, monobactams and carbapenems).

Pregnancy and lactation:

Pregnancy

Cefriaxon penetrates the placental barrier. The safety of use during pregnancy in women has not been established. The use of the drug during pregnancy is possible only in cases where the expected benefit to the mother exceeds potential risk for the fetus.

Breastfeeding period

Ceftriaxone is excreted in breast milk. If it is necessary to use the drug during lactation, breastfeeding should be stopped.

Directions for use and dosage:

Standard dosage regimen

Synergism between ceftriaxone and aminoglycosides has been shown against many gram-negative bacteria. Although the increased effectiveness of such combinations is not always predictable, it should be taken into account in severe, life-threatening infections such as due to Pseudomonasaeruginosa.

Special instructions:

Hypersensitivity reactions

Like other β-lactam antibiotics, severe hypersensitivity reactions, some fatal, have been reported with ceftriaxone. If a severe hypersensitivity reaction develops, drug therapy should be discontinued immediately and appropriate emergency treatment should be carried out. therapeutic measures. Before starting drug therapy, it is necessary to determine whether the patient has had hypersensitivity reactions to ceftriaxone, cephalosporins or severe hypersensitivity reactions to other β-lactam antibiotics (penicillins, monobactams and carbapenems).

Caution should be exercised when using ceftriaxone in patients with a history of mild hypersensitivity reactions to other β-lactam antibiotics (penicillins, monobactams and carbapenems).

1 g of the drug contains 3.6 mmol of sodium. This should be taken into account in patients on a sodium controlled diet.

Hemolytic anemia

Like other cephalosporins, when treated with the drug, the development of autoimmune hemolytic anemia is possible. Cases of severe hemolytic anemia have been reported in adults and children, including deaths. If anemia develops in a patient being treated with ceftriaxone, the diagnosis of cephalosporin-associated anemia cannot be excluded and treatment must be discontinued until the cause is determined.

Diarrhea , recognized by Clostridium difficile

Like most other antibacterial drugs, cases of diarrhea caused by ceftriaxone have been reported. Clostridiumdifficile(WITH. difficile ) , varying in severity: from mild diarrhea to fatal colitis. Treatment antibacterial drugs suppresses normal microflora colon and provokes growth C. difficile. In its turn, C. difficile produces toxins A and B, which are factors in the pathogenesis of diarrhea caused by C. difficile. Strains C. difficile, hyperproducing toxins, are causative agents of infections with high risk complications and mortality due to their possible resistance to antimicrobial therapy, and treatment may require colectomy. It is necessary to remember the possibility of developing diarrhea caused by C. difficile, in all patients with diarrhea after antibiotic therapy. A thorough history taking is necessary, because cases of diarrhea caused by C. difficile, more than 2 months after antibiotic therapy. If diarrhea caused by C. difficile it may be necessary to cancel the current one that is not aimed at S. dificile, antibiotic therapy. Depending on the clinical indications, appropriate treatment should be prescribed with the introduction of fluids and electrolytes, proteins, and antibiotic therapy for C. difficile, surgery. Do not use medications that inhibit intestinal motility.

Superinfections

As with treatment with other antibacterial drugs, superinfections may develop.

Changes in prothrombin time

Rare cases of changes in prothrombin time have been described in patients receiving the drug. Patients with vitamin K deficiency (impaired synthesis, malnutrition) may require monitoring of prothrombin time during therapy and administration of vitamin K (10 mg per week) with an increase in prothrombin time before or during therapy.

Formation of precipitates of ceftriaxone calcium salt

Cases of fatal reactions resulting from the deposition of ceftriaxone-calcium precipitates in the lungs and kidneys of newborns have been described. Theoretically, there is a possibility that ceftriaxone may interact with calcium-containing intravenous solutions in others. age groups patients, therefore should not be mixed with calcium-containing solutions (including for parenteral nutrition), and also administered simultaneously, including through separate infusion accesses at different sites. Theoretically, based on the calculation of the 5 half-lives of ceftriaxone, the interval between the administration of ceftriaxone and calcium-containing solutions should be at least 48 hours. Data on the possible interaction of ceftriaxone with calcium-containing drugs for oral administration, as well as ceftriaxone for intramuscular administration with calcium-containing drugs (intravenously or orally) are not available. After using ceftriaxone, usually in doses exceeding the standard recommended (1 g per day or more), with ultrasound examination gallbladder, precipitates of the calcium salt of ceftriaxone were detected, the formation of which is most likely in pediatric patients. Precipitates rarely cause any symptoms and disappear after completion or cessation of drug therapy. If these phenomena are accompanied clinical symptoms, conservative non-surgical treatment is recommended, and the decision to discontinue the drug is left to the discretion of the treating physician and should be based on an individual assessment of benefit and risk. Although there is evidence of the formation of intravascular precipitates only in neonates when using ceftriaxone and calcium-containing infusion solutions or any other calcium-containing drugs, the drug should not be mixed or administered to children and adult patients simultaneously with calcium-containing infusion solutions, even using different venous approaches.

Pancreatitis

Rare cases of pancreatitis, which may have developed as a result of bile duct obstruction, have been described in patients receiving the drug. Most of these patients already had risk factors for congestion in the biliary tract, for example, previous therapy, serious illnesses and completely parenteral nutrition. At the same time, it is impossible to exclude the triggering role in the development of pancreatitis of precipitates formed under the influence of the drug in the biliary tract.

Use in children

The safety and effectiveness of the drug in neonates, infants and young children have been determined at the dosages described in the section "Dosage and Administration". Studies have shown that, like other cephalosporins, it can displace bilirubin from binding to serum albumin.

The drug should not be used in newborns, especially premature infants, who are at risk of developing bilirubin encephalopathy.

Long-term treatment

At long-term treatment it is necessary to regularly monitor the peripheral blood picture, indicators functional state liver and kidneys.

Blood test monitoring

During long-term treatment, a complete blood count should be performed regularly.

Serological studies

In rare cases, during treatment with the drug, patients may experience false positives Coombs tests, tests for galactosemia, when determining glucose in urine (glucosuria, if necessary, should be determined only by the enzyme method).

Impact on the ability to drive vehicles. Wed and fur.:

Due to the possibility of dizziness and other undesirable reactions during drug therapy, care must be taken when driving vehicles and working with potentially dangerous mechanisms.

Release form/dosage:

Powder for solution for intravenous and intramuscular administration, 250 mg, 500 mg and 1000 mg.

Package:

250 mg, 500 mg or 1000 mg each active substance(ceftriaxone) in glass bottles (type II) with a capacity of 10 ml, hermetically sealed with rubber stoppers, crimped with aluminum or combined caps of the “FLIPP OFF” type. A label is attached to each bottle.

Each bottle, along with instructions for use, is placed in a cardboard pack.

100 bottles along with an equal number of instructions for use are placed in a cardboard tray covered with shrink film (for hospital use).

Storage conditions:

At a temperature not exceeding 30 °C.

Keep out of the reach of children. Best before date:

Do not use after expiration date.

Conditions for dispensing from pharmacies: On prescription Registration number: LP-003970 Registration date: 18.11.2016 Expiration date: 18.11.2021 Owner of the Registration Certificate: CHIMPHARM, JSC Kazakhstan Manufacturer:   Representative office:   AKRIKHIN JSC Russia Information update date:   13.12.2016 Illustrated instructions

Catad_pgroup Antibiotics cephalosporins

Ceftriaxone - instructions for use

Registration number

Trade name of the drug: Ceftriaxone

International nonproprietary name:

Ceftriaxone

Chemical name:]-7-[[(2-Amino-4-thiazolyl)(methoxyimino)acetyl]amino]-8-oxo-3-[[(1,2,5,6-tetrahydro-2-methyl-5,6- dioxo-1,2,4-triazin-3-yl)thio]methyl]-5-thia-1-azabicyclooct-2-ene-2-carboxylic acid (as di sodium salt).

Compound:

One bottle contains 1.0 g of Ceftriaxone sodium salt.

Description:
Almost white or yellowish crystalline powder.

Pharmacotherapeutic group:

antibiotic, cephalosporin

ATX Code.

Pharmacological properties
Ceftriaxone is a third-generation cephalosporin antibiotic for parenteral use, has a bactericidal effect, inhibits cell membrane synthesis, and in vitro inhibits the growth of most Gram-positive and Gram-negative microorganisms. Ceftriaxone is resistant to beta-lactamase enzymes (both penicillinase and cephalosporinase, produced by most Gram-positive and Gram-negative bacteria). In vitro and under conditions clinical practice Ceftriaxone is usually effective against the following microorganisms:
Gram positive:
Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Streptococcus A (Str. pyogenes), Streptococcus V (Str. agalactiae), Streptococcus viridans, Streptococcus bovis.
Note: Staphylococcus spp., resistant to methicillin, is also resistant to cephalosporins, including ceftriaxone. Most strains of enterococci (eg Streptococcus faecalis) are also resistant to ceftriaxone.
Gram negative:
Aeromonas spp., Alcaligenes spp., Branhamella catarrhalis, Citrobacter spp., Enterobacter spp. (some strains are resistant), Escherichia coli, Haemophilus ducreyi, Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella spp. (including Kl. pneumoniae), Moraxella spp., Morganella morganii, Neisseria gonorrhoeae, Neisseria meningitidis, Plesiomonas shigelloides, Proteus mirabilis, Proteus vulgaris, Providencia spp., Pseudomonas aeruginosa(some strains are resistant), Salmonella spp. (including S. typhi), Serratia spp. (including S. marcescens), Shigella spp., Vibrio spp. (including V. cholerae), Yersinia spp. (including Y. enterocolitica)
Note: Many strains of the listed microorganisms, which multiply steadily in the presence of other antibiotics, for example, penicillins, first-generation cephalosporins and aminoglycosides, are sensitive to ceftriaxone. Treponema pallidum is sensitive to ceftriaxone both in vitro and in animal experiments. According to clinical data during primary and secondary syphilis noted good effectiveness of ceftriaxone.
Anaerobic pathogens:
Bacteroides spp. (including some strains of B. fragilis), Clostridium spp. (including CI. difficile), Fusobacterium spp. (except F. mostiferum. F. varium), Peptococcus spp., Peptostreptococcus spp.
Note: Some strains of many Bacteroides spp. (eg B. fragilis) that produce beta-lactamase are resistant to ceftriaxone. To determine the sensitivity of microorganisms, it is necessary to use disks containing ceftriaxone, since it has been shown that in vitro certain strains of pathogens can be resistant to classical cephalosporins.

Pharmacokinetics:
When administered parenterally, ceftriaxone penetrates well into body tissues and fluids. In healthy adult subjects, ceftriaxone has a long half-life of about 8 hours. Area under the concentration-time curve in serum during intravenous and intramuscular injection match up. This means that the bioavailability of ceftriaxone when administered intramuscularly is 100%. When administered intravenously, ceftriaxone quickly diffuses into the interstitial fluid, where it retains its bactericidal effect against pathogens sensitive to it for 24 hours.
The half-life in healthy adult subjects is approximately 8 hours. In neonates up to 8 days and in elderly people over 75 years of age, the average half-life is approximately twice as long. In adults, 50-60% of ceftriaxone is excreted unchanged in the urine, and 40-50% is also excreted unchanged in the bile. Under the influence of intestinal flora, ceftriaxone is converted into an inactive metabolite. In newborns, approximately 70% of the administered dose is excreted by the kidneys. In case of renal failure or liver pathology in adults, the pharmacokinetics of ceftriaxone remains almost unchanged, the elimination half-life is slightly extended. If renal function is impaired, excretion into bile increases, and if liver pathology occurs, then excretion of ceftriaxone by the kidneys increases.
Ceftriaxone binds reversibly to albumin and this binding is inversely proportional to the concentration: for example, at a drug concentration in the blood serum of less than 100 mg/l, the protein binding of ceftriaxone is 95%, and at a concentration of 300 mg/l it is only 85%. Thanks to more low content albumin in the interstitial fluid, the concentration of ceftriaxone in it is higher than in the blood serum.
Penetration into the cerebrospinal fluid: In newborns and children with inflammation of the meninges, ceftriaxone penetrates into the cerebrospinal fluid, while in the case of bacterial meningitis, an average of 17% of the drug concentration in the blood serum diffuses into the cerebrospinal fluid, which is approximately 4 times more than with aseptic meningitis. 24 hours after intravenous administration of ceftriaxone at a dose of 50-100 mg/kg body weight, the concentration in the cerebrospinal fluid exceeds 1.4 mg/l. In adult patients with meningitis, 2-25 hours after administration of ceftriaxone at a dose of 50 mg/kg body weight, the concentration of ceftriaxone many times exceeded the minimum inhibitory dose necessary to suppress the pathogens that most often cause meningitis.

Indications for use:

Infections caused by pathogens sensitive to ceftriaxone: sepsis, meningitis, abdominal infections (peritonitis, inflammatory diseases of the gastrointestinal tract, biliary tract), infections of bones, joints, connective tissue, skin, infections in patients with reduced immune system function, kidney and urinary tract infections, respiratory tract infections, especially pneumonia, as well as ear, nose and throat infections, genital infections, including gonorrhea. Preventing infections in postoperative period.

Directions for use and dosage:

For adults and children over 12 years old: The average daily dose is 1-2 g of ceftriaxone once a day (every 24 hours). In severe cases or in cases of infections caused by moderately susceptible pathogens, the single daily dose may be increased to 4 g.
For newborns, infants and children under 12 years of age: With a one-time daily dosage The following scheme is recommended:
For newborns (up to two weeks of age): 20-50 mg/kg body weight per day (the dose of 50 mg/kg body weight is not allowed to be exceeded due to the immature enzyme system of newborns).
For infants and children under 12 years of age: The daily dose is 20-75 mg/kg body weight. In children weighing 50 kg or more, the adult dosage should be followed. A dose of more than 50 mg/kg body weight should be administered as an intravenous infusion according to at least within 30 minutes.
Duration of therapy: depends on the course of the disease.
Combination therapy:
Experiments have proven that there is a synergism between ceftriaxone and aminoglycosides in their effect on many Gram-negative bacteria. Although the potentiated effect of such combinations cannot be predicted in advance, in cases of severe and life-threatening infections (for example, those caused by Pseudomonas aeruginosa), their combined use is justified.
Due to the physical incompatibility of ceftriaxone and aminoglycosides, they must be prescribed separately in recommended doses!
Meningitis:
For bacterial meningitis in newborns and children, the initial dose is 100 mg/kg body weight once a day (maximum 4 g). As soon as we managed to isolate pathogen and determine its sensitivity, the dose must be reduced accordingly. The best results were achieved with the following periods of therapy:
Gonorrhea:
For the treatment of gonorrhea caused by both penicillinase-forming and non-penicillinase-forming strains, the recommended dose is 250 mg once intramuscularly.
Prevention in the pre- and postoperative period:
Before infected or suspected infected surgical procedures, to prevent postoperative infections, depending on the risk of infection, a single administration of ceftriaxone in a dose of 1-2 g is recommended 30-90 minutes before surgery.
Insufficiency of kidney and liver function:
In patients with impaired renal function, provided normal function liver, there is no need to reduce the dose of ceftriaxone. Only in case of preterminal renal failure (creatinine clearance below 10 ml/min) is it necessary that the daily dose of ceftriaxone does not exceed 2 g.
In patients with impaired liver function, provided that renal function is preserved, there is also no need to reduce the dose of ceftriaxone.
In cases of simultaneous presence of severe liver and kidney pathology, the concentration of ceftriaxone in the blood serum must be regularly monitored. In patients undergoing hemodialysis, there is no need to change the dose of the drug after this procedure.
Intramuscular administration:
For intramuscular administration, 1 g of the drug must be diluted in 3.5 ml of a 1% lidocaine solution and injected deep into the gluteal muscle; it is recommended to inject no more than 1 g of the drug into one buttock. Lidocaine solution should never be administered intravenously!
Intravenous administration:
For intravenous injection, 1 g of the drug must be diluted in 10 ml of sterile distilled water and administered intravenously slowly over 2-4 minutes.
Intravenous infusion:
Duration of intravenous infusion is at least 30 minutes. For intravenous infusion, 2 g of powder must be diluted in approximately 40 ml of a calcium-free solution, for example: 0.9% sodium chloride solution, 5% glucose solution, 10% glucose solution, 5% levulose solution.

Side effects:
Systemic side effects:
from the gastrointestinal tract (about 2% of patients): diarrhea, nausea, vomiting, stomatitis and glossitis.
Changes in the blood picture (about 2% of patients) in the form of eosinophilia, leukopenia, granulocytopenia, hemolytic anemia, thrombocytopenia.
Skin reactions (about 1% of patients) in the form of exanthema, allergic dermatitis, urticaria, edema, erythema multiforme.
Other rare side effects: headaches, dizziness, increased liver enzymes, gallbladder congestion, oliguria, increased serum creatinine, mycoses in the genital area, chills, anaphylaxis or anaphylactic reactions. Pseudomembranous enterocolitis and blood clotting disorders are extremely rare.
Local side effects:
After intravenous administration, phlebitis was observed in some cases. This phenomenon can be prevented by slow (over 2-4 minutes) administration of the drug. The described side effects usually disappear after stopping therapy.

Contraindications:

Hypersensitivity to cephalosporins and penicillins. First trimester of pregnancy.

Drug interactions:
Do not mix in the same infusion bottle or in the same syringe with another antibiotic (chemical incompatibility).

Overdose:

Excessively high plasma concentrations of ceftriaxone cannot be lowered by hemodialysis or peritoneal dialysis. Symptomatic measures are recommended to treat cases of overdose.

Special instructions:

Despite a detailed history taking, which is also the rule for other cephalosporin antibiotics, the possibility of developing anaphylactic shock, which requires immediate therapy - first, adrenaline is administered intravenously, then glucocorticoids.
Sometimes an ultrasound examination of the gallbladder reveals the presence of a shadow, indicating sedimentation. This symptom disappears after completion or temporary cessation of ceftriaxone therapy. Even if there is pain syndrome Such cases do not require surgical intervention; conservative treatment is sufficient.
In vitro studies have shown that, like other cephalosporin antibiotics, ceftriaxone is able to displace bilirubin bound to serum albumin. Therefore, in newborns with hyperbilirubinemia and, especially, in premature newborns, the use of ceftriaxone requires even greater caution. Since the drug passes into breast milk, breastfeeding should not be continued during treatment with ceftriaxone.
With long-term use, periodic monitoring of the blood count is necessary. Ceftriaxone is used only in hospital settings

Release form
Powder for the preparation of solution for injection, 1.0 g in glass bottles, each bottle is packed in a cardboard box with instructions for medical use.

Storage conditions
In a place protected from light, at a temperature not exceeding 25°C. Keep out of the reach of children.

Best before date
2 years.
Do not use after the expiration date stated on the package.

Conditions for dispensing from pharmacies
Dispensed with a doctor's prescription.

Manufacturer:

"Vertex Exports", India.

Comments

(visible only to specialists verified by the MEDI RU editorial team)

Ceftriaxone - price, availability in pharmacies

The price at which you can buy Ceftriaxone in Moscow is indicated. You will receive the exact price in your city after switching to the online medicine ordering service.

Ceftriaxone is a semi-synthetic antibiotic of the third generation cephalosporin that is distinguished by the breadth of its antibacterial “outlook”.

The main property of this antibiotic is that it is produced exclusively in the form of injections for injections. The effectiveness of Ceftriaxone is due to such a factor as blocking the production of a special substance murein, through which microorganisms are neutralized and destroyed.

In vitro ( clinical significance remains unknown) activity is noted against strains of the following bacteria: Citrobacter diversus and freundii, Salmonella spp. (including against Salmonella typhi), Providencia spp. (including in relation to Providencia rettgeri), Shigella spp.; Bacteroides bivius, Streptococcus agalactiae, Bacteroides melaninogenicus.

Clinical and pharmacological group

III generation cephalosporin.

Terms of sale from pharmacies

Can buy according to a doctor's prescription.

Price

How much does Ceftriaxone cost in pharmacies? average price is at the level of 35 rubles.

Composition and release form

The drug Ceftriaxone is available in powder form for the preparation of a solution for intramuscular and intravenous administration.

Crystalline powder, white, odorless, available in bottles made of clear glass in a cardboard box, the drug is accompanied by detailed instructions describing the characteristics of the antibiotic. Each bottle contains 1 g of active active substance– Ceftriaxone in the form of sodium salt.

Pharmacological effect

Ceftriaxone is a new generation antibiotic. It is effective against most gram-positive and gram-negative microorganisms that can grow both in the presence of oxygen and in an oxygen-free environment. Antimicrobial action Ceftriaxone is caused by suppression of the synthesis of cell membranes of pathogenic bacteria.

The drug has a high penetrating ability, so for the treatment of most infections it is enough to use Ceftriaxone once a day. Already one to two hours after injection of the drug into the muscle, highest concentration Ceftriaxone in the blood. When administered intramuscularly, the entire volume medicine completely absorbed by the body. After a one-time intravenous administration, the maximum concentration of the drug in the blood is achieved within half an hour after the procedure.

When introduced into the body, Ceftriaxone accumulates in it in maximum quantity and remains at this level throughout the day. Largest quantity The antibiotic is concentrated in the musculoskeletal system, lungs, heart, liver, and gall bladder. The drug is able to penetrate the placental barrier and affect the condition of the fetus; when treating nursing mothers, a certain concentration of the antibiotic is observed in breast milk.

Indications for use

What does it help with? Ceftriaxone has found successful use in combating infectious and inflammatory diseases:

1. For otitis media;
2. Typhoid fever;
3. Bacterial septicemia;
4. Related bone tissue, skin and joints;
5. Respiratory organs (meningitis, pneumonia, pleurisy, epiglottitis, sinusitis, lung abscess);
6. Urogenital infections (urethritis, epidermatitis, pyelitis);
7. Prostate gland (prostatitis);
8. Sexually transmitted diseases (gonorrhea, chancroid);
9. Abdominal cavity (angiocholitis, peritonitis);
10. Skin ();
11. Tick-borne borreliosis (Lyme disease).

To stabilize health after various types operations (removal of appendicitis, gallbladder, postpartum) ceftriaxone injections are also prescribed.

Contraindications

Ceftriaxone is not prescribed in case of known hypersensitivity to cephalosporin antibiotics or auxiliary components of the drug.

Relative contraindications:

• the neonatal period if the child has hyperbilirubinemia;
• prematurity;
• renal/liver failure;
• enteritis, UC or colitis associated with the use of antibacterial agents;
• pregnancy;
• lactation.

Prescription during pregnancy and lactation

The drug is contraindicated in the first trimester of pregnancy. If it is necessary to prescribe to a nursing woman, the child should be switched to formula.

Reviews of Ceftriaxone during pregnancy confirm that the drug is indeed a very powerful and very effective antibacterial agent that can not only cure the underlying disease, but also prevent the development of its complications.

Considering that the drug (like other antibiotics) has side effects, it is prescribed only in cases where there is potential possible complications diseases can cause more harm than the use of medicine (in particular, with infections of the urogenital tract, to which pregnant women are very susceptible).

Dosage and method of administration

As indicated in the instructions for use, Ceftriaxone is administered intramuscularly and intravenously (stream or drip).

For adults and children over 12 years of age, the dose is 1-2 g once a day or 0.5-1 g every 12 hours. The maximum daily dose is 4 g.

For newborns (up to 2 weeks of age) the dose is 20-50 mg/kg per day

For infants and children under 12 years of age, the daily dose is 20-80 mg/kg. In children weighing 50 kg or more, adult doses are used.

A dose of more than 50 mg/kg body weight should be administered as an intravenous infusion over 30 minutes. The duration of treatment depends on the nature and severity of the disease.

For bacterial meningitis in infants and young children, the dose is 100 mg/kg 1 time per day. The maximum daily dose is 4 g. The duration of therapy depends on the type of pathogen and can range from 4 days for meningitis caused by Neisseria meningitidis, to 10-14 days for meningitis caused by susceptible strains of Enterobacteriaceae.

For the treatment of gonorrhea, the dose is 250 mg IM, once.

To prevent postoperative infectious complications, a single dose of 1-2 g is administered (depending on the degree of risk of infection) 30-90 minutes before the start of surgery. During operations on the colon and rectum, additional administration of a drug from the group of 5-nitroimidazoles is recommended.

For children with skin and soft tissue infections, the drug is prescribed in a daily dose of 50-75 mg/kg body weight once a day or 25-37.5 mg/kg every 12 hours, but not more than 2 g per day. For severe infections of other localizations - at a dose of 25-37.5 mg/kg every 12 hours, but not more than 2 g per day.

For otitis media, the drug is administered intramuscularly at a dose of 50 mg/kg body weight, but not more than 1 g.

In patients with impaired renal function, dose adjustment is required only in cases of severe renal failure (creatinine clearance less than 10 ml/min), in which case the daily dose of ceftriaxone should not exceed 2 g.

How many days to inject the drug?

The duration of treatment depends on what pathogenic microflora causes the disease, as well as on the characteristics clinical picture. If the causative agent is Gram (-) diplococci of the genus Neisseria, the best results can be achieved in 4 days, if enterobacteria are sensitive to the drug - in 10-14 days.

Ceftriaxone injections: instructions for use. How to dilute the drug?

A solution is used to dilute the antibiotic. Lidocaine (1 or 2%) or water for injection (d/i).

When using water d/i, it should be taken into account that intramuscular injections of the drug are very painful, so if the solvent is water, discomfort will occur both during the injection and for some time after it.

Water for diluting the powder is usually taken in cases where the use Lidocaine impossible due to the patient's allergies on him.

The best option is a one percent solution Lidocaine . It is better to use water for aid, when diluting the drug Lidocaine 2%.

Is it possible to dilute Novocaine with Ceftriaxone?

Novocaine when used to dilute the drug, it reduces the activity antibiotic , while simultaneously increasing the likelihood of the patient developing anaphylactic shock .

Based on the reviews of the patients themselves, they note that Lidocaine better than Novocaine , relieves pain when Ceftriaxone is administered.

In addition, the use of a non-freshly prepared solution of Ceftriaxone with Novocaine , contributes to increased pain during injection (the solution remains stable for 6 hours after preparation).

How to dilute Ceftriaxone with Novocaine?

If used as a solvent Novocaine , it is taken in a volume of 5 ml per 1 g of the drug. If you take a smaller amount Novocaine , the powder may not completely dissolve, and the syringe needle will become clogged with lumps of medicine.

Dilution with Lidocaine 1%

For injection into the muscle, 0.5 g of the drug is dissolved in 2 ml of a one percent solution Lidocaine (contents of one ampoule); For 1 g of the drug take 3.6 ml of solvent.

The dosage of 0.25 g is diluted in the same way as 0.5 g, that is, with the contents of 1 ampoule of 1% Lidocaine . After this, the finished solution is drawn into different syringes, half the volume in each.

The medicine is injected deep into the gluteal muscle (no more than 1 g in each buttock).

Diluted Lidocaine the drug is not intended for intravenous administration. It is allowed to be injected strictly into the muscle.

How to dilute Ceftriaxone injections with Lidocaine 2%?

To dilute 1 g of the drug, take 1.8 ml of water and two percent Lidocaine . To dilute 0.5 g of the drug, also mix 1.8 ml Lidocaine with 1.8 ml of water d/i, but only half of the resulting solution (1.8 ml) is used for dissolution. To dilute 0.25 g of the drug, take 0.9 ml of a solvent prepared in a similar way.

Ceftriaxone: how to dilute children for intramuscular administration?

The given method of intramuscular injections is practically not used in pediatric practice, since Ceftriaxone with novocaine can cause severe anaphylactic shock , and in combination with lidocaine - may contribute to the occurrence seizures and cardiac dysfunction.

For this reason, the optimal solvent when using the drug in children is ordinary water. The inability to use painkillers in childhood requires even slower and more careful administration of the drug in order to reduce painful sensations during the injection.

Dilution for intravenous administration

For intravenous administration, 1 g of the drug is dissolved in 10 ml of distilled water (sterile). The drug is administered slowly over 2-4 minutes.

Dilution for intravenous infusion

When carrying out infusion therapy, the drug is administered for at least half an hour. To prepare a solution, 2 g of powder is diluted in 40 ml of Ca-free solution: dextrose (5 or 10%), NaCl (0,9%), fructose (5%).

Additionally

Ceftriaxone is intended exclusively for parenteral administration: Manufacturers do not produce tablets and suspensions due to the fact that antibiotic in contact with body tissues, it exhibits high activity and greatly irritates them.

Adverse reactions

During treatment with the drug in patients with hypersensitivity to cephalosporins, adverse reactions, which clinically manifest as follows:

• from the outside nervous system– lethargy, drowsiness, lethargy, dizziness, paresthesia, sometimes convulsions and encephalopathy;
• from the digestive system - stomatitis in the mouth, heartburn, belching, nausea, loss of appetite, vomiting, diarrhea with streaks of blood in the stool, development ulcerative colitis, liver dysfunction, development of acute liver failure in severe cases;
• from the reproductive system - vaginal dysbiosis, itching of the external genitalia, fungal diseases, the appearance vaginal discharge with an unpleasant odor;
• from the respiratory system - cough, bronchospasm, nosebleeds, dry nose;
• from the cardiovascular system - tachycardia, peripheral edema;
  development of superinfection;
• local reactions - puncture of a vein, formation of a hematoma, burning and pain along the vein during drug administration, phlebitis, blockage of the vein by air bubbles; with intramuscular injection of an antibiotic, a dense painful infiltrate forms at the injection site, redness, itching of the skin.
• allergic reactions - rashes and itching of the skin, allergic dermatitis, toxic epidermal necrolysis, development of Quincke's edema, anaphylactic shock;
• from the blood system indicators - leukopenia, decreased platelet levels, agranulocytopenia, hemolytic anemia, prolongation of prothrombin time;
• from the urinary organs - development interstitial nephritis, development of acute renal failure;

If sweating, dizziness, darkening of the eyes and severe weakness occur during intravenous administration of the solution, the patient should immediately inform the doctor and stop the injection.

Overdose symptoms

Signs of a drug overdose are convulsions and central nervous system stimulation. Peritoneal dialysis and hemodialysis are ineffective in reducing ceftriaxone concentrations. The medicine does not have an antidote.

Therapy: symptomatic.

special instructions

Before you start using the drug, read the special instructions:

1. Elderly and debilitated patients may require vitamin K.
2. With long-term treatment, it is necessary to regularly monitor the peripheral blood picture, indicators of the functional state of the liver and kidneys.
3. With simultaneous severe renal and liver failure, in patients on hemodialysis, the concentration of the drug in plasma should be regularly determined.
4. In rare cases, an ultrasound of the gallbladder reveals dark spots that disappear after stopping treatment (even if this phenomenon is accompanied by pain in the right hypochondrium, it is recommended to continue prescribing the antibiotic and carry out symptomatic treatment).
5. During treatment, you should not drink alcohol, since disulfiram-like effects are possible (redness of the face, spasms in the abdomen and stomach area, nausea, vomiting, headache, decreased blood pressure, tachycardia, shortness of breath).
6. Despite a detailed history taking, which is the rule for other cephalosporin antibiotics, the possibility of developing anaphylactic shock, which requires immediate treatment, is not excluded - first epinephrine is administered intravenously, then GCS.
7. In vitro studies have shown that, like other cephalosporin antibiotics, ceftriaxone is able to displace bilirubin bound to serum albumin. Therefore, in newborns with hyperbilirubinemia and, especially in premature newborns, the use of Ceftriaxone requires even greater caution.

Store the prepared solution at room temperature for no more than 6 hours or in the refrigerator at a temperature of 2-8 ° C for no more than 24 hours.

Compatibility with other drugs

When using the drug, it is necessary to take into account interactions with other medications:

1. Incompatible with ethanol.
2. Ceftriaxone, by suppressing intestinal flora, prevents the synthesis of vitamin K.
3. When administered simultaneously with drugs that reduce platelet aggregation (NSAIDs, salicylates, sulfinpyrazone), the risk of bleeding increases. When administered simultaneously with anticoagulants, an increase in the effect of the latter is observed.
4. When administered concomitantly with loop diuretics, the risk of nephrotoxicity increases.
5. Ceftriaxone and aminoglycosides are synergistic against many gram-negative bacteria.