Ceftriaxone must be injected strictly according to the doctor's prescription, the average course is 7-10 days, but in severe cases it can be extended up to two weeks. The minimum duration (5 days) is recommended for mild illness and for stepwise therapy, that is, when switching from Ceftriaxone to tablets. Longer treatment is needed for streptococcal infection, chronic inflammation, moderate and severe disease.

Adults are administered 1-2 g 1 time per day, a child 20-80 mg per 1 kg of body weight. Diluted with 1% Lidocaine solution. With meningitis, a maximum dose of 4 g for an adult and 100 mg / kg for a child can be prescribed for 2-3 days before the pathogen is determined, according to the results of the analysis, the course of injections is set for 5-7 days.

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

the severity of the disease - with a mild infection, 5-7 days may be enough, with moderate severity, 10 days will be needed, and severe forms will require about 2 weeks;
acuteness of the inflammatory reaction - in acute forms, the course is shorter;
the state of the immune system - with a decrease in immunity, the treatment is longer;
pathogen - for example, in acute uncomplicated gonorrhea, the antibiotic is administered only 1 time, and in case of streptococcal infection, it should be injected for at least 10 days;
the use of other drugs - when switching to antibiotic tablets according to the stepwise therapy scheme, you can limit yourself to a minimum course of 5 days;
the result achieved - when there is no improvement in the condition for 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 response to the drug according to objective data:

symptom reduction;
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 probing the abdomen with inflammation in the abdominal cavity);
results of blood tests, urine and instrumental diagnostics.

The duration of treatment is tentatively determined by lowering 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 (seeding results, blood tests).

How to breed

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

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

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

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

Is it possible during pregnancy

It has been established that it crosses the placenta from mother to fetus. So far, there is no confirmed evidence that the antibiotic is completely harmless to the child. Doctors can only rely on animal studies that have not revealed abnormalities in the development of the fetus or deterioration in the course of 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 a day of normal temperature, it is most often prescribed for another 2-3 days.

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

The maximum duration of antibiotic therapy in the elderly has not been established, but it is imperative to monitor the functioning of the liver and kidneys, and tolerability of the drug. If complications occur or threaten to develop, the doctor may recommend changing the medication or prescribe medications that have a protective effect on:

immunity - Derinat, Polyoxidonium;
kidneys - Kanefron, Nefrosten;
liver - Essentiale, Gepabene;
intestines - Enterol, Lactobacterin, Lineks;
metabolic processes - Alphabet in the season of colds, Supradin Immuno Forte;
the development of a fungal infection - Fluconazole.

Watch this video for instructions on how to use Ceftriaxone:

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

With otitis media

In acute otitis media, Ceftriaxone is administered at a dose of 1-2 g for about 7 days, it is indicated for severe course, temperature over 38 degrees and severe pain. The doctor may prescribe it for:

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

With 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 and 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;
worsening of the condition after ARVI (second wave of the disease);
inflammatory changes in the blood.

With cystitis

For meningitis

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

meningococcal infection - 5 days;
Haemophilus influenzae was sown - 6 days;
streptococcal meningitis - 7 days.

Interval between injections of Ceftriaxone

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

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

How much ceftriaxone can i inject a child

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 rises to 80-100 mg / kg.

Diagnosis	How many days to inject children
Bronchitis with frequent exacerbations
Pneumonia
Acute sinusitis
Acute otitis media	7, but if a child attends a kindergarten, or he is under 2 years old, there is a purulent discharge, then 10
Angina
Acute inflammation of the bladder
Pyelonephritis	10 with the transition to tablets or 14 with the introduction of only Ceftriaxone

Precautions for 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 deaths have been reported with its use due to:

an anaphylactic reaction (extremely rapid development of an allergy), therefore, if redness, itching of the skin, swelling, difficulty breathing appear, you should immediately stop the injections and consult a doctor;
autoimmune anemia (antibodies are formed that destroy erythrocytes) - if a decrease in erythrocytes and hemoglobin is detected, you should find out if this is associated with an antibiotic; you cannot administer Ceftriaxone before the examination;
due to colitis (pseudomembranous) and uncontrolled reproduction of bacteria (clostridia), with frequent stools and painful urges, you should not try to normalize the stool 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 improve the effectiveness of therapy and prevent complications, it is recommended:

drink at least 1.5 liters of water, include enough protein in the diet (fish, chicken, sour-milk drinks, cottage cheese);
with 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 monitors the treatment, prescribes an examination, determines the risks of adverse reactions.

Watch this video about why you should not dilute Ceftriaxone with Lidocaine and what it threatens the patient with:

Possible complications from injections

With the introduction of Ceftriaxone, local complications are possible:

soreness, burning sensation when injected;
tightness in the buttock;
phlebitis.

The most common common reactions include:

accession of a fungal infection (thrush);
allergy;
abdominal pain, diarrhea;
precipitation of salts in the biliary and urinary tract;
changes in the blood - a decrease in erythrocytes, platelets, leukocytes.

The effectiveness of the drug

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

bronchi and lungs - bronchitis, pneumonia, abscess, accumulation of pus in the pleural cavity;
ear, throat, nose - tonsillitis, sinusitis, acute;
skin and soft tissue infections - pyoderma, phlegmon, abscess, carbuncle;
inflammation of the urinary tract - pyelonephritis, cystitis;
infectious process in the abdominal cavity - peritonitis, cholangitis, pus in the gallbladder (empyema), pancreatitis;
pelvic diseases - endometritis;
bacterial meningitis;
heart valve disease - 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 to 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, controls the treatment and identifies the risks of side effects.

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

Composition and form of release

Ceftriaxone is produced in the form of a powder for preparing a solution in glass vials 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

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

This drug is resistant to the action of beta-lactamase. Means shows wide bactericidal action. It is active against aerobic gram-negative and gram-positive microorganisms, as well as anaerobic microorganisms.

After i / m administration, Ceftriaxone is rapidly and completely absorbed into the systemic circulation. It penetrates well into tissues and body fluids: respiratory tract, bones, joints, urinary tract, skin, subcutaneous tissue and abdominal organs. With inflammation of the meningeal membranes, it penetrates well into the cerebrospinal fluid.

What helps ceftriaxone?

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

ear, throat, nose;
sepsis;
gonorrhea;
skin and soft tissues;
genital organs;
disseminated Lyme borreliosis in the 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 immunocompromised patients;
pelvic organs;
wound infections.

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

Instructions for use

Ceftriaxone is administered intramuscularly and intravenously (by jet or drip).

For adults and children over 12 years old, the dose is 1-2 g 1 time per day or 0.5-1 g every 12 hours. The maximum daily dose is 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, it is administered once at a dose of 1-2 g (depending on the degree of risk of infection) 30-90 minutes before the start of the operation. 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 in severe renal insufficiency (CC less than 10 ml / min), in which case the daily dose of ceftriaxone should not exceed 2 g.

Ceftriaxone for children with infections of the skin and soft tissues is prescribed in a daily dose of 50-75 mg / kg of body weight 1 time / day or 25-37.5 mg / kg every 12 hours, but not more than 2 g per day. In 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 greater than 50 mg/kg body weight should be given as an IV infusion over 30 minutes. The duration of the course 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 the age of 2 weeks), the dose is 20-50 mg / kg per day.

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, up to 10-14 days for meningitis caused by susceptible strains of Enterobacteriaceae.

With otitis media, the drug is administered intramuscularly at a dose of 50 mg/kg of 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 injections, 500 mg of the drug is dissolved in 2 ml, and 1 g of the drug in 3.5 ml of a 1% lidocaine solution. It is recommended to inject no more than 1 g into one gluteal muscle.
Dilution for intramuscular use can also be carried out using water for injection. The effect is the same, only there will be a more painful introduction.
To prepare a solution for intravenous injection, 500 mg of the drug is dissolved in 5 ml, and 1 g of the drug in 10 ml of 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 solutions that do not contain calcium: 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 for known hypersensitivity to cephalosporin antibiotics or auxiliary components of the drug.

Relative contraindications:

the neonatal period if the child has hyperbilirubinemia;
prematurity;
kidney 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 of the body:

anaphylactic shock;
hypercreatininemia;
flatulence;
stomatitis, glossitis;
taste disorder;
dysbacteriosis;
oliguria, impaired renal function;
abdominal pain;
diarrhea;
increased urea content;
glycosuria;
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 necessary, the appointment of a nursing woman, the child should be transferred to the mixture.

Dosage form: P powder for solution for intravenous and intramuscular administration. Compound: For 1 vial:

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:

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

Pharmacotherapeutic group:cephalosporin antibiotic ATX:

J.01.D.D.04 Ceftriaxone

Pharmacodynamics:

Ceftriaxone is a third generation parenteral cephalosporin antibiotic. The bactericidal activity of ceftriaxone is due to the suppression of the synthesis of cell membranes. has a wide spectrum of action 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 are also stable.

Gram-negative aerobes

Acinetobacter lwoffii, Acinetobacter anitratus( mainly, A. baumannii)*,Aeromonas hydrophila, Alcaligenes faecalis, Alcaligenes odorans, alkaline gene-like bacteria, Borrelia burgdorferi, Capnocytophaga spp., Citrobacter diversu s (including C. amalonaticus), Citrobacter freundii*, Escherichia coli, Enterobacter aerogenes*, Enterobacter cloacae, Enterobacter spp.(other)*, Haemophilus ducreyi , Haemophilus influenzae , Haemophilus parainfluenzae , Hafnia alvei , Klebsiella oxytoca , Klebsiella pneumoniae **, Moraxella catarrhalis(previously called Branhamella catarrhalis), Moraxella osloensis, Moraxella spp.. (other), Morganella morganii, Neisseria gonorrhoeae, Neisseria meningitidis, Pasteurella multocida, Plesiomonas shigelloides, Proteus mirabilis, Proteus penneri*, Proteus vulgaris*, Pseudomonas fluorescens*, Pseudomonas spp.(other), Providencia rettgeri*, Providencia spp.(other), Salmonella typhi, Salmonella spp.(non-typhoid), Serratia marcescens*, Serratia spp. (other)*, 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, multi-resistant 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 efficacy against primary and secondary syphilis. With very few exceptions, clinical isolates R. aeruginosa resistant to ceftriaxone.

Anaerobes

Bacteroides spp.(biliary sensitive)*, Clostridium spp. ( except for S. difficile), Fusobacterium nucleatum, Fusobacterium spp. (other), 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 strains of β-lactamase-forming bacteria are resistant to ceftriaxone.Bacteroides spp. (in particularB. fragilis). sustainable andClostridium difficile.

Susceptibility to ceftriaxone can be determined by disk diffusion or serial dilution on agar or broth using a standard procedure such as that recommended by the Clinical and Laboratory Standards Institute (ICLS). The FIC has established the following criteria for evaluating test results for ceftriaxone:

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

To determine, you should take disks with ceftriaxone, because. in researchin vitroshown to be active against individual strains that show resistance when using disks designed for the entire group of cephalosporins.

Instead of IKLS 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), allowing to adequately interpret the state of sensitivity.

Pharmacokinetics:

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

Suction

The maximum plasma concentration after a single intramuscular injection of 1 g of the drug is about 81 mg / l and is reached within 2-3 hours after administration. The areas under the curve "plasma concentration - time" 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 mean maximum plasma concentration was 120 mg/mL and 200 mg/L, respectively. After intravenous infusion of 500 mg, 1 g and 2 g of ceftriaxone, plasma concentrations of the drug were approximately 80, 150 and 250 mg/l, respectively. After intramuscular injection, the value of the average maximum concentration of ceftriaxone in blood plasma is approximately two times lower than after intravenous administration of an equivalent dose of the drug.

Distribution

The volume of distribution of ceftriaxone is 7-12 liters. After administration at 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 cerebrospinal, pleural and synovial fluids and secretions). prostate).

Ceftriaxone rapidly diffuses into the cerebrospinal fluid, where it retains its bactericidal action against sensitive microorganisms for 24 hours.

Ceftriaxone binds reversibly to albumin. The degree of binding decreases with increasing concentration: at a drug concentration in blood plasma of less than 100 mg / l, the binding of ceftriaxone is 95%, and at a concentration of 300 mg / l - 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 through the meninges, to the greatest extent during their inflammation. The average 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 reached 4-6 hours after its intravenous administration. passes through the placental barrier and in small concentrations passes into breast milk.

Metabolism

Ceftriaxone is not subject to systemic metabolism, but is converted to inactive metabolites by the intestinal flora.

breeding

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% - unchanged through the intestines. The half-life of ceftriaxone in adults is about 8 hours.

Pharmacokinetics in special clinical situations

At newborn babies 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 rate and the peculiarities of drug binding to blood plasma proteins.

At pediatric patients up to 12 years of age the half-life is shorter than in newborns and adults.

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

Patients With dysfunction of the kidneys or liver the pharmacokinetics of ceftriaxone changes slightly, there is only a slight increase in the half-life (less than 2 times) even in patients with severe renal insufficiency.

If only kidney function is impaired, biliary excretion increases; if only liver function is impaired, excretion through the kidneys increases.

At patients older than 75 years the half-life is, on average, two or three times longer than in adult patients.

Indications:

Infections caused by pathogens sensitive to the drug: sepsis; meningitis; disseminated Lyme disease (II and III stages of the disease); infections of the upper and lower respiratory tract, especially pneumonia, and infections of the upper respiratory tract; 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 infection prevention.

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

In premature infants up to and including 41 weeks of age (cumulative gestational and chronological age), the use of ceftriaxone is contraindicated.

Term neonates (≤ 28 days of age)

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

Intravenous administration of calcium-containing solutions to newborns.

Newborns (≤ 28 days) who are already prescribed or expected to receive intravenous treatment with calcium-containing solutions, including prolonged calcium-containing infusions, for example, with parenteral nutrition, due to the risk of precipitation of calcium salts of ceftriaxone (see sections "Method of administration and doses" and "Interaction with other drugs). Separate fatal cases of the formation of precipitates in the lungs and kidneys in newborns who also received calcium-containing solutions are described. At the same time, in some cases, a single venous access was used, and the formation of precipitates was observed directly in the system for intravenous administration, at least one case with a fatal outcome was also described with different venous accesses and different times of administration of ceftriaxone and calcium-containing solutions. Similar cases were observed only at newborns (see the subsection "Post-registration Surveillance").

Lidocaine

Before 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 the medical use of lidocaine. Solutions of ceftriaxone containing should not be administered intravenously.

Carefully:

The period of breastfeeding; history of non-severe hypersensitivity reactions to other β-lactam antibiotics (penicillins, monobactams and carbapenems).

Pregnancy and lactation:

Pregnancy

Cefriaxone crosses 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 intended benefit to the mother outweighs the potential risk to the fetus.

breastfeeding period

Ceftriaxone is excreted in breast milk. If necessary, the use of the drug during lactation should stop breastfeeding.

Dosage and administration:

Standard dosing regimen

Synergism between ceftriaxone and aminoglycosides has been shown for many Gram-negative bacteria. Although the increased efficacy of such combinations is not always predictable, it should be considered in severe, life-threatening infections such as Pseudomonasaeruginosa.

Special instructions:

Hypersensitivity reactions

Like other β-lactam antibiotics, severe hypersensitivity reactions, including fatal ones, have been reported with ceftriaxone. With the development of a severe hypersensitivity reaction, drug therapy should be immediately canceled and appropriate urgent therapeutic measures should be taken. Before starting therapy with the drug, it is necessary to establish whether the patient has experienced 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, autoimmune hemolytic anemia may develop during treatment with the drug. Cases of severe hemolytic anemia have been reported in adults and children, including fatal cases. If anemia develops in a patient treated with ceftriaxone, the diagnosis of cephalosporin-associated anemia cannot be ruled out and treatment should be discontinued until the cause is clarified.

Diarrhea , known Clostridium difficile

Like most other antibacterial drugs, cases of diarrhea caused by Clostridiumdifficile(WITH. difficile ) varying in severity from mild diarrhea to fatal colitis. Treatment with antibacterial drugs suppresses the normal microflora of the colon and provokes growth C. difficile. In turn, C. difficile forms toxins A and B, which are factors in the pathogenesis of diarrhea caused by C. difficile. Strains C. difficile, overproducing toxins, are the causative agents of infections with a high risk of complications and mortality, due to their possible resistance to antimicrobial therapy, treatment may require colectomy. Be aware of the possibility of developing diarrhea caused by C. difficile, in all patients with diarrhea after antibiotic therapy. Careful history taking is necessary, as cases of diarrhea caused by C. difficile more than 2 months after antibiotic therapy. If diarrhea is suspected or confirmed due to C. difficile it may be necessary to cancel the current, not aimed at C. dificile, antibiotic therapy. Depending on the clinical indications, appropriate treatment should be prescribed with the introduction of fluid and electrolytes, proteins, antibiotic therapy for C. difficile, surgery. Do not use drugs that inhibit intestinal motility.

Superinfections

As with other antibiotics, 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 the appointment of vitamin K (10 mg per week) with an increase in prothrombin time before or during therapy.

Precipitation of ceftriaxone calcium salt

Cases of fatal reactions as a result of the deposition of ceftriaxone-calcium precipitates in the lungs and kidneys of newborns are described. Theoretically, there is a possibility of interaction of ceftriaxone with calcium-containing solutions for intravenous administration in other age groups of patients, therefore, it should not be mixed with calcium-containing solutions (including for parenteral nutrition), and also administered simultaneously, including through separate accesses for infusions at different sites . Theoretically, based on the calculation of 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 oral calcium-containing drugs, as well as intramuscular ceftriaxone with calcium-containing drugs (intravenously or for oral reception) are not available. After the use of ceftriaxone, usually at doses exceeding the standard recommended (1 g per day or more), ultrasound examination of the gallbladder revealed precipitates of ceftriaxone calcium salt, the formation of which is most likely in pediatric patients. Precipitates rarely give any symptoms and disappear after completion or discontinuation of drug therapy. If these events are accompanied by clinical symptoms, conservative non-surgical treatment is recommended, and the decision to discontinue the drug is left to the discretion of the attending physician and should be based on an individual assessment of benefit and risk. Despite the presence of data on the formation of intravascular precipitates only in newborns 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 adults simultaneously with calcium-containing infusion solutions, even using different venous accesses.

pancreatitis

Rare cases of pancreatitis have been described in patients receiving the drug, possibly due to obstruction of the biliary tract. Most of these patients already had risk factors for biliary congestion, such as prior therapy, severe disease, and total parenteral nutrition. At the same time, it is impossible to exclude the starting 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 efficacy of the drug in neonates, infants and young children have been determined for the dosages described in the "Dosage and Administration" section. Studies have shown that, like other cephalosporins, it can displace bilirubin from its association with serum albumin.

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

Long term treatment

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

Blood test monitoring

With 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-positive results of the Coombs test, a test for galactosemia, when determining glucose in the urine (glucosuria, if necessary, should be determined only by the enzymatic method).

Influence on the ability to drive transport. cf. and fur.:

Due to the possibility of developing dizziness and other adverse 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 of the active substance (ceftriaxone) in glass vials (type II) with a capacity of 10 ml, hermetically sealed with rubber stoppers, crimped with aluminum or combined caps of the FLIPP OFF type. Each bottle is labeled.

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

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

Storage conditions:

At a temperature not higher than 30 °C.

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

Do not use after the expiration date.

Conditions for dispensing from pharmacies: On prescription Registration number: LP-003970 Date of registration: 18.11.2016 Expiration date: 18.11.2021 Registration certificate holder: HIMFARM JSC Kazakhstan Manufacturer: Representation: 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 non-proprietary 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-azabicyclo oct-2-ene-2-carboxylic acid (as disodium salt).

Compound:

One vial 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 in clinical practice, ceftriaxone is generally effective against the following organisms:
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 these microorganisms, which stably multiply in the presence of other antibiotics, such as 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, ceftriaxone is effective in primary and secondary syphilis.
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, disks containing ceftriaxone should be used, 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 tissues and body fluids. In healthy adults, ceftriaxone has a long half-life of about 8 hours. The area under the curve concentration - time in the blood serum with intravenous and intramuscular injection coincide. This means that the bioavailability of ceftriaxone when administered intramuscularly is 100%. When administered intravenously, ceftriaxone rapidly diffuses into the interstitial fluid, where it retains its bactericidal action against susceptible pathogens for 24 hours.
The elimination half-life in healthy adults is about 8 hours. In newborns up to 8 days old and in the elderly over 75 years of age, the mean elimination half-life is about 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 the intestinal flora, ceftriaxone is converted to an inactive metabolite. In newborns, approximately 70% of the administered dose is excreted by the kidneys. In case of kidney failure or liver pathology in adults, the pharmacokinetics of ceftriaxone almost does not change, the elimination half-life lengthens slightly. If kidney function is impaired, excretion with 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 concentration: for example, at a drug concentration in the blood serum of less than 100 mg / l, the binding of ceftriaxone to proteins is 95%, and at a concentration of 300 mg / l - only 85%. Due to the lower content of albumin in the interstitial fluid, the concentration of ceftriaxone in it is higher than in the blood serum.
Penetration into the cerebrospinal fluid: In neonates 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 concentration of the drug in the blood serum diffuses into the cerebrospinal fluid, which is about 4 times more than in aseptic meningitis. 24 hours after intravenous administration of ceftriaxone at a dose of 50-100 mg/kg of body weight, the concentration in the cerebrospinal fluid exceeds 1.4 mg/l. In adult patients with meningitis, 2-25 hours after the administration of ceftriaxone at a dose of 50 mg/kg of body weight, the concentration of ceftriaxone was many times higher than the minimum inhibitory dose that is necessary to suppress the pathogens that most often cause meningitis.

Indications for use:

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

Dosage and administration:

For adults and children over 12 years of age: The average daily dose is 1-2 g of ceftriaxone once a day (after 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: With a single daily dosage, the following scheme is recommended:
For newborns (up to two weeks of age): 20-50 mg / kg of body weight per day (a dose of 50 mg / kg of body weight should not be exceeded due to the immature enzyme system of newborns).
For infants and children under 12: the daily dose is 20-75 mg/kg of body weight. In children weighing 50 kg or more, the adult dosage should be followed. A dose greater than 50 mg/kg body weight should be administered as an intravenous infusion over at least 30 minutes.
Duration of therapy: depends on the course of the disease.
Combination Therapy:
Experiments have shown that there is 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 joint administration is justified.
Due to the physical incompatibility of ceftriaxone and aminoglycosides, it is necessary to prescribe them at the recommended doses separately!
Meningitis:
For bacterial meningitis in neonates and children, the initial dose is 100 mg/kg body weight once a day (maximum 4 g). As soon as it was possible to isolate the pathogenic microorganism and determine its sensitivity, the dose should be reduced accordingly. The best results were achieved with the following terms 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 interventions, to prevent postoperative infections, depending on the risk of infection, a single administration of ceftriaxone at 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 that liver function is normal, there is no need to reduce the dose of ceftriaxone. Only in case of kidney failure in the preterminal stage (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 kidney function is preserved, there is no need to reduce the dose of ceftriaxone.
In cases of simultaneous presence of severe pathology of the liver and kidneys, the concentration of ceftriaxone in the blood serum should 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% solution of Lidocaine 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 injected slowly intravenously over 2-4 minutes.
Intravenous infusion:
The 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: in 0.9% sodium chloride solution, in 5% glucose solution, in 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 activity of liver enzymes, congestion in the gallbladder, oliguria, increased serum creatinine, fungal infections in the genital area, chills, anaphylaxis or anaphylactic reactions. Extremely rarely, pseudomembranous enterocolitis and a violation of blood coagulation are noted.
Local side effects:
After intravenous administration, phlebitis was noted in some cases. This phenomenon can be prevented by slow (within 2-4 minutes) administration of the drug. The described side effects usually disappear after cessation of therapy.

Contraindications:

Hypersensitivity to cephalosporins and penicillins. First trimester of pregnancy.

Drug interaction:
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 reduced by hemodialysis or peritoneal dialysis. Symptomatic measures are recommended for the treatment of 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 cannot be ruled out, which requires immediate treatment - first adrenaline is administered intravenously, then glucocorticoids.
Sometimes an ultrasound of the gallbladder shows a shadow indicating sedimentation. This symptom disappears after the end or temporary discontinuation of ceftriaxone therapy. Even in the presence of pain, 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 prolonged use, periodic monitoring of the blood formula is necessary. Ceftriaxone is used only in a hospital setting.

Release form
Powder for solution for injection, 1.0 g in glass vials, each vial 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 expiry date stated on the packaging.

Terms of dispensing from pharmacies
Released by prescription.

Manufacturer:

"Vertex Exports", India.

Comments

(visible only to specialists verified by the editors of MEDI RU)

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 ordering service for medicines.

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

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, as well as their destruction.

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 against Providencia rettgeri), Shigella spp.; Bacteroides bivius, Streptococcus agalactiae, Bacteroides melaninogenicus.

Clinical and pharmacological group

3rd generation cephalosporin.

Terms of sale from pharmacies

Can buy by prescription.

Price

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

Composition and form of release

Ceftriaxone is available as a powder for solution for intramuscular and intravenous administration.

The powder is crystalline, white, odorless, produced in transparent glass bottles in a cardboard box, the preparation is accompanied by detailed instructions describing the characteristics of the antibiotic. Each vial contains 1 g of the active ingredient - 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. The antimicrobial effect of Ceftriaxone is due to the suppression of the synthesis of cell membranes of pathogenic bacteria.

The drug is highly penetrating, so for the treatment of most infections, it is enough to apply Ceftriaxone once a day. Already one to two hours after the injection of the drug into the muscle, the highest concentration of Ceftriaxone in the blood is observed. When administered intramuscularly, the entire volume of the drug is completely absorbed by the body. After a single intravenous injection, the maximum concentration of the drug in the blood is reached within half an hour after the procedure.

When introduced into the body, Ceftriaxone accumulates in it in the maximum amount and remains at this level during the day. The greatest amount of the antibiotic is concentrated in the musculoskeletal system, lungs, heart, liver, gallbladder. The drug is able to penetrate the placental barrier and affect the condition of the fetus; in the treatment of nursing mothers, a certain concentration of the antibiotic is noted in breast milk.

Indications for use

What helps? Ceftriaxone has been successfully used in combating infectious and inflammatory diseases:

With otitis;
typhoid fever;
bacterial septicemia;
Associated with bone tissue, skin and joints;
Respiratory organs (meningitis, pneumonia, pleurisy, epiglottitis, sinusitis, lung abscess);
Urogenital infections (urethritis, epidermitis, pyelitis);
prostate gland (prostatitis);
Venereal diseases (, gonorrhea, chancroid);
Abdominal cavity (angiocholitis, peritonitis);
Skin ();
Tick-borne borreliosis (Lyme disease).

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

Contraindications

Ceftriaxone is not prescribed for 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.

Appointment during pregnancy and lactation

The drug is contraindicated in the first trimester of pregnancy. If necessary, the appointment of a nursing woman, the child should be transferred to the mixture.

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.

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

Dosage and method of application

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

For adults and children over 12 years old, the dose is 1-2 g 1 time per day or 0.5-1 g every 12 hours. The maximum daily dose is 4 g.

For newborns (up to the age of 2 weeks), 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 greater than 50 mg/kg body weight should be given as an IV infusion over 30 minutes. The duration of the course of treatment depends on the nature and severity of the disease.

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

For children with infections of the skin and soft tissues, the drug is prescribed in a daily dose of 50-75 mg / kg of body weight 1 time / day or 25-37.5 mg / kg every 12 hours, but not more than 2 g per day. In 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.

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

In patients with impaired renal function, dose adjustment is required only in severe renal insufficiency (CC 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 caused the disease, as well as on the characteristics of the clinical picture. If the causative agent is Gram (-) diplococci of the genus Neisseria, the best results can be achieved in 4 days, if enterobacteria 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 for injections, it should be borne in mind that intramuscular injections of the drug are very painful, so if the solvent is water, there will be discomfort both during the injection and for some time after it.

Water for dilution of the powder is usually taken in cases where the use Lidocaine impossible because the patient has allergies on him.

The best option is a one percent solution Lidocaine . Water d / and is better to use as an aid, when diluting the drug Lidocaine 2%.

Can Ceftriaxone be diluted with Novocain?

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

Based on the feedback from the patients themselves, they note that Lidocaine better than Novocaine , relieves pain with the introduction of Ceftriaxone.

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

How to breed Ceftriaxone Novocain?

If it is still 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 dissolve completely, and the syringe needle may become clogged with medicine lumps.

Dilution with Lidocaine 1%

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

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

The drug 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 enter 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 for injection and two percent Lidocaine . To dilute 0.5 g of the drug, also mix 1.8 ml Lidocaine with 1.8 ml of water for injection, 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 breed children for intramuscular injection?

The given technique for intramuscular injections is practically not used in pediatric practice, since Ceftriaxone with novocaine can cause the child the strongest anaphylactic shock , and in combination with lidocaine - may contribute to convulsions and disruption of the heart.

For this reason, the optimal solvent in the case of the use of the drug in children is ordinary water for injection. The impossibility of using painkillers in childhood requires an even slower and more careful administration of the drug in order to reduce pain during the injection.

Breeding 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 conducting infusion therapy, the drug is administered for at least half an hour. To prepare a solution, 2 g of the powder is diluted in 40 ml of a 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 the tissues of the body, it is highly active and strongly irritates them.

Adverse reactions

During treatment with the drug in patients with hypersensitivity to cephalosporins, adverse reactions may occur, which are clinically manifested as follows:

from the nervous system - lethargy, drowsiness, lethargy, dizziness, paresthesia, sometimes convulsions and encephalopathy;
on the part of the digestive system - stomatitis in the mouth, heartburn, belching, nausea, loss of appetite, vomiting, diarrhea with streaks of blood in the feces, development of ulcerative colitis, impaired liver function, development of acute liver failure in severe cases;
on the part of the reproductive system - vaginal dysbacteriosis, itching of the external genital organs, fungal diseases, the appearance of vaginal discharge with an unpleasant odor;
on the part of 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 the administration of the drug, phlebitis, blockage of the vein with air bubbles, with intramuscular administration of an antibiotic, a dense painful infiltrate, redness, and itching of the skin form at the injection site.
allergic reactions - rashes and itching of the skin, allergic dermatitis, toxic epidermal necrolysis, development of Quincke's edema, anaphylactic shock;
on the part of the indicators of the blood system - leukopenia, a decrease in the level of platelets, agranulocytopenia, hemolytic anemia, prolongation of prothrombin time;
on the part of the urinary organs - the development of interstitial nephritis, the development of acute renal failure;

In the event of sweating, dizziness, darkening of the eyes and severe weakness at the time of intravenous injection, the patient should immediately inform the doctor about this and stop the injection.

Overdose symptoms

Signs of an overdose of the drug are convulsions and excitation of the central nervous system. Peritoneal dialysis and hemodialysis are not effective in reducing the concentration of ceftriaxone. The medicine has no antidote.

Therapy: symptomatic.

special instructions

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

Elderly and debilitated patients may require the appointment of vitamin K.
With long-term treatment, it is necessary to regularly monitor the picture of peripheral blood, indicators of the functional state of the liver and kidneys.
With simultaneous severe renal and hepatic insufficiency, in patients on hemodialysis, plasma concentrations of the drug should be regularly determined.
In rare cases, ultrasound of the gallbladder shows blackouts that disappear after stopping treatment (even if this phenomenon is accompanied by pain in the right hypochondrium, it is recommended to continue prescribing an antibiotic and performing symptomatic treatment).
During treatment, you can not drink alcohol, since disulfiram-like effects are possible (flushing of the face, spasm in the abdomen and in the stomach, nausea, vomiting, headache, lowering blood pressure, tachycardia, shortness of breath).
Despite a detailed history taking, which is also the rule for other cephalosporin antibiotics, the possibility of developing anaphylactic shock cannot be ruled out, which requires immediate therapy - epinephrine is administered intravenously first, then corticosteroids.
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 a 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 the interaction with other drugs:

Incompatible with ethanol.
Ceftriaxone, by suppressing the intestinal flora, prevents the synthesis of vitamin K.
With simultaneous appointment with drugs that reduce platelet aggregation (NSAIDs, salicylates, sulfinpyrazone), the risk of bleeding increases. With simultaneous appointment with anticoagulants, an increase in the action of the latter is noted.
With simultaneous appointment with "loop" diuretics, the risk of developing a nephrotoxic effect increases.
Ceftriaxone and aminoglycosides are synergistic against many Gram-negative bacteria.