CEFTRIAXONE injectable

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    Last updated: September 2023

     

    Prescription under medical supervision

     

    Therapeutic action

    • Third-generation cephalosporin antibacterial

    Indications

    • Severe bacterial infections: septicaemia, meningitis, pneumonia, typhoid fever, shigellosis, leptospirosis, tick-borne relapsing fevers, pyelonephritis, neurosyphilis, etc.
    • Cervicitis, urethritis and conjunctivitis due to Neisseria gonorrhoeae (in combination with a treatment for chlamydia, except in neonates), chancroid

    Forms and strengths, route of administration

    • Powder for injection, in 250 mg or 1 g vials, to be dissolved:
      • with the solvent containing lidocaine for IM injection only. DO NOT ADMINISTER BY IV INJECTION OR INFUSION the solution reconstituted with this solvent.
      • with water for injection for slow IV injection (3 minutes) or infusion (30 minutes) in 0.9% sodium chloride or 5% glucose

    Dosage and duration

    Severe bacterial infections

    The dose varies according to indication:

    • Child 1 month and over (< 50 kg): 50 to 100 mg/kg (max. 4 g) once daily 
    • Child 50 kg and over and adult: 1 to 2 g once daily (up to 2 g 2 times daily or 4 g once daily for meningitis and typhoid fever)

    Duration varies according to indication and clinical response. Change to oral treatment as soon as possible. The choice of oral antibiotic depends on indication.

     

    Gonococcal cervicitis and urethritis, chancroid

    • Child under 45 kg: 125 mg IM single dose
    • Child 45 kg and over and adult: 500 mg IM single dose (250 mg IM single dose for chancroid)

     

    Gonococcal conjunctivitis

    • Neonate: 50 mg/kg IM single dose (max. 125 mg)
    • Adult: 1 g IM single dose

     

    For administration by IV route, ceftriaxone powder is to be dissolved in water for injection only. For administration by IV infusion, dilute each dose of ceftriaxone in 5 ml/kg of 0.9% sodium chloride or 5% glucose in children less than 20 kg and in a bag of 100 ml of 0.9% sodium chloride or 5% glucose in children 20 kg and over and in adults.

    Contra-indications, adverse effects, precautions

    • Do not administer to patients with allergy to cephalosporins or penicillins (cross-sensitivity may occur) and to neonates with jaundice (risk of bilirubin encephalopathy) or receiving calcium gluconate (risk of precipitation of ceftriaxone-calcium salts in lungs and kidneys). 
    • Administer with caution in patients with hepatic or renal impairment. Reduce dosage in patients with severe renal impairment (max. 50 mg/kg daily or 2 g daily in IV).
    • May cause: gastrointestinal disturbances, hepatic dysfunction, blood disorders (anaemia, leucopenia, neutropenia), renal dysfunction; allergic reactions sometimes severe (Stevens-Johnson syndrome).
    • Do not mix ceftriaxone with calcium-containing solutions such as Ringer lactate (risk of particulate formation).
    • Pregnancy: no contra-indication
    • Breast-feeding: no contra-indication

    Remarks

    • Doses greater than 1 g IM should be administered in 2 equally divided injections (one in each buttock).
      Doses greater than 2 g should be administered by IV infusion only.
    • Do not mix with another drug in the same syringe or infusion.

    Storage

     

    –  Below 25 °C 
    Once reconstituted, the solution must be used immediately.

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