Formulary
Ceftriaxone: Indications, Dosing, Side Effects and Interactions
Cephalosporins are antibacterials that attach to penicillin binding proteins to interrupt cell wall biosynthesis, leading to bacterial cell lysis and death.
MedNext Academy | 22 min read
Ceftriaxone: Indications, Dosing, Side Effects and Interactions
Cephalosporins are antibacterials that attach to penicillin binding proteins to interrupt cell wall biosynthesis, leading to bacterial cell lysis and death.
Drug action
Cephalosporins are antibacterials that attach to penicillin binding proteins to interrupt cell wall biosynthesis, leading to bacterial cell lysis and death.
Indications and dose
**Community-acquired pneumonia,Intra-abdominal infections,Complicated urinary-tract infections,Acute exacerbations of chronic obstructive pulmonary disease**
- **Adult** (By Intravenous Infusion, Or By Intravenous Injection, Or By Deep Intramuscular Injection): 1-2 g once daily, 2 g dose to be used for severe cases.
**Hospital-acquired pneumonia**
- **Adult** (By Intravenous Infusion, Or By Intravenous Injection, Or By Deep Intramuscular Injection): 2 g once daily.
**Cellulitis,Erysipelas,Moderate diabetic foot infection,Severe diabetic foot infection,Leg ulcer infection**
- **Adult** (By Intravenous Injection, Or By Intravenous Infusion): 2 g once daily.
**Prophylaxis of infection from human bites [in combination with other drugs],Prophylaxis of infection from animal bites [in combination with other drugs],Treatment of infection from human bites [in combination with other drugs],Treatment of infection from animal bites [in combination with other drugs]**
- **Adult** (By Intravenous Injection, Or By Intravenous Infusion): 2 g once daily.
**Complicated skin and soft tissue infections,Infections of bones and joints**
- **Adult** (By Intravenous Infusion, Or By Intravenous Injection, Or By Deep Intramuscular Injection): 2 g once daily.
**Suspected bacterial infection in neutropenic patients**
- **Adult** (By Intravenous Infusion, Or By Intravenous Injection): 2-4 g once daily, doses at the higher end of the recommended range used in severe cases.
- **Adult** (By Deep Intramuscular Injection): 2 g once daily, increased if necessary up to 4 g daily in 2 divided doses, doses at the higher end of the recommended range used in severe cases.
**Suspected meningococcal disease [pre-hospital treatment],Suspected bacterial meningitis [pre-hospital treatment where there is likely to be a clinically significant delay in transfer to hospital]**
- **Child** (By Deep Intramuscular Injection): 9-11 years 2 g for 1 dose, administer prior to urgent transfer to hospital unless this will delay transfer. The actual dose given should be communicated to the receiving hospital, where the childs weight should be obtained as soon as possible and the remainder of the dose given if necessary (see dosing for Bacterial meningitis and Meningococcal disease ).
- **Child** (By Intravenous Injection, Or By Deep Intramuscular Injection): 12-17 years 2 g for 1 dose, administer prior to urgent transfer to hospital unless this will delay transfer.
- **Adult** (By Intravenous Injection, Or By Deep Intramuscular Injection): 2 g for 1 dose, administer prior to urgent transfer to hospital unless this will delay transfer.
**Bacterial meningitis,Meningococcal disease**
- **Adult** (By Intravenous Infusion, Or By Intravenous Injection): 2 g every 12 hours, alternatively 4 g once daily.
- **Child** (By Intravenous Infusion): 12-17 years 2 g every 12 hours, alternatively 4 g once daily.
- **Child** (By Intravenous Injection): 12-17 years 2 g every 12 hours, alternatively 4 g once daily.
**Bacterial endocarditis**
- **Adult** (By Intravenous Infusion, Or By Intravenous Injection): 2-4 g once daily, doses at the higher end of the recommended range used in severe cases.
- **Child** (By Intravenous Infusion): 12-17 years 2-4 g once daily, doses at the higher end of the recommended range used in severe cases.
- **Child** (By Intravenous Injection): 12-17 years 2-4 g once daily, doses at the higher end of the recommended range used in severe cases.
- **Child** (By Deep Intramuscular Injection): 12-17 years 2 g once daily, increased if necessary up to 4 g daily in 2 divided doses, doses at the higher end of the recommended range used in severe cases.
- **Adult** (By Deep Intramuscular Injection): 2 g once daily, increased if necessary up to 4 g daily in 2 divided doses, doses at the higher end of the recommended range used in severe cases.
**Surgical prophylaxis**
- **Adult** (By Intravenous Infusion, Or By Intravenous Injection, Or By Deep Intramuscular Injection): 2 g for 1 dose, dose to be administered 30-90 minutes before procedure.
**Pelvic inflammatory disease**
- **Child** (By Deep Intramuscular Injection): 12-17 years (body-weight 45 kg and above) 1 g for 1 dose.
- **Adult** (By Deep Intramuscular Injection): 1 g for 1 dose.
**Uncomplicated gonorrhoea [anogenital and pharyngeal infection]**
- **Child** (By Deep Intramuscular Injection): 12-17 years (body-weight 45 kg and above) 1 g for 1 dose.
- **Adult** (By Deep Intramuscular Injection): 1 g for 1 dose.
**Gonococcal conjunctivitis**
- **Adult** (By Deep Intramuscular Injection): 1 g for 1 dose.
**Gonococcal epididymo-orchitis**
- **Adult** (By Deep Intramuscular Injection): 1 g for 1 dose, to be followed by an additional antibacterial course to treat epididymo-orchitis.
**Disseminated gonococcal infection**
- **Adult** (By Deep Intramuscular Injection, Or By Intravenous Infusion, Or By Intravenous Injection): 1 g every 24 hours.
**Disseminated gonococcal infection [arthritis and arthritis-dermatitis syndrome]**
- **Adult** (By Deep Intramuscular Injection, Or By Intravenous Infusion, Or By Intravenous Injection): 1 g every 24 hours for 7 days, may be switched 24-48 hours after symptoms improve to a suitable oral antibacterial.
**Disseminated gonococcal infection [gonococcal meningitis]**
- **Adult** (By Intravenous Infusion, Or By Intravenous Injection): 1-2 g every 12-24 hours for 10-14 days.
**Disseminated gonococcal infection [gonococcal endocarditis]**
- **Adult** (By Intravenous Infusion, Or By Intravenous Injection): 1-2 g every 12-24 hours for at least 4 weeks.
**Syphilis**
- **Adult** (By Intravenous Infusion, Or By Intravenous Injection, Or By Deep Intramuscular Injection): 0.5-1 g once daily for 10-14 days, dose increased to 2 g once daily for neurosyphilis.
**Lyme disease [affecting central nervous system]**
- **Adult** (By Intravenous Infusion, Or By Intravenous Injection): 2 g twice daily for 21 days, alternatively 4 g once daily for 21 days.
**Lyme arthritis,Acrodermatitis chronica atrophicans**
- **Adult** (By Intravenous Infusion, Or By Intravenous Injection): 2 g once daily for 28 days.
**Lyme carditis**
- **Adult** (By Intravenous Infusion, Or By Intravenous Injection): 2 g once daily for 21 days.
**Prevention of secondary case of meningococcal meningitis**
- **Adult** (By Deep Intramuscular Injection): 250 mg for 1 dose.
**Prevention of secondary case ofHaemophilus influenzaetype b disease**
- **Adult** (By Deep Intramuscular Injection, Or By Intravenous Injection, Or By Intravenous Infusion): Prevention of secondary case of Haemophilus influenzae type b disease 1 g once daily for 2 days.
**Acute otitis media**
- **Adult** (By Deep Intramuscular Injection): 1-2 g for 1 dose, dose can be given for 3 days if severely ill or previous therapy failed.
**Acute prostatitis**
- **Adult** (By Slow Intravenous Injection, Or By Intravenous Infusion): 2 g once daily.
**Community-acquired pneumonia, Intra-abdominal infections, Complicated urinary-tract infections for ceftriaxone**
- **Neonate up to 15 days** (By intravenous infusion): 20-50 mg/kg once daily, doses at the higher end of the recommended range used in severe cases.
- **Neonate 15 days to 28 days** (By intravenous infusion): 50-80 mg/kg once daily, doses at the higher end of the recommended range used in severe cases.
- **Child 1 month-11 years (body-weight up to 50 kg)** (By intravenous infusion): 50-80 mg/kg once daily, doses at the higher end of the recommended range used in severe cases.
- **Child 9-11 years (body-weight 50 kg and above)** (By intravenous infusion): 1-2 g once daily, 2 g dose to be used for severe cases.
- **Child 12-17 years** (By intravenous infusion): 1-2 g once daily, 2 g dose to be used for severe cases.
- **Child 9-11 years (body-weight 50 kg and above)** (By intravenous injection): 1-2 g once daily, 2 g dose to be used for severe cases.
- **Child 12-17 years** (By intravenous injection): 1-2 g once daily, 2 g dose to be used for severe cases.
- **Child 1 month-11 years (body-weight up to 50 kg)** (By deep intramuscular injection): 50-80 mg/kg daily, doses at the higher end of the recommended range used in severe cases.
- **Child 9-11 years (body-weight 50 kg and above)** (By deep intramuscular injection): 1-2 g once daily, 2 g dose to be used for severe cases.
- **Child 12-17 years** (By deep intramuscular injection): 1-2 g once daily, 2 g dose to be used for severe cases.
**Hospital-acquired pneumonia for ceftriaxone**
- **Neonate up to 15 days** (By intravenous infusion): 20-50 mg/kg once daily, doses at the higher end of the recommended range used in severe cases.
- **Neonate 15 days to 28 days** (By intravenous infusion): 50-80 mg/kg once daily, doses at the higher end of the recommended range used in severe cases.
- **Child 1 month-11 years (body-weight up to 50 kg)** (By intravenous infusion): 50-80 mg/kg once daily, doses at the higher end of the recommended range used in severe cases.
- **Child 9-11 years (body-weight 50 kg and above)** (By intravenous infusion): 2 g once daily.
- **Child 12-17 years** (By intravenous infusion): 2 g once daily.
- **Child 9-11 years (body-weight 50 kg and above)** (By intravenous injection): 2 g once daily.
- **Child 12-17 years** (By intravenous injection): 2 g once daily.
- **Child 1 month-11 years (body-weight up to 50 kg)** (By deep intramuscular injection): 50-80 mg/kg daily, doses at the higher end of the recommended range used in severe cases.
- **Child 9-11 years (body-weight 50 kg and above)** (By deep intramuscular injection): 2 g once daily.
- **Child 12-17 years** (By deep intramuscular injection): 2 g once daily.
**Prophylaxis of infection from human bites [in combination with other drugs], Prophylaxis of infection from animal bites [in combination with other drugs], Treatment of infection from human bites [in combination with other drugs], Treatment of infection from animal bites [in combination with other drugs] for ceftriaxone**
- **Child 1 month-11 years (body-weight up to 50 kg)** (By intravenous infusion): 50-80 mg/kg once daily.
- **Child 9-11 years (body-weight 50 kg and above)** (By intravenous infusion): 1-2 g once daily.
- **Child 12-17 years** (By intravenous infusion): 1-2 g once daily.
- **Child 9-11 years (body-weight 50 kg and above)** (By intravenous injection): 1-2 g once daily.
- **Child 12-17 years** (By intravenous injection): 1-2 g once daily.
**Complicated skin and soft tissue infections, Infections of bones and joints for ceftriaxone**
- **Neonate up to 15 days** (By intravenous infusion): 20-50 mg/kg once daily, doses at the higher end of the recommended range used in severe cases.
- **Neonate 15 days to 28 days** (By intravenous infusion): 50-100 mg/kg once daily, doses at the higher end of the recommended range used in severe cases.
- **Child 1 month-11 years (body-weight up to 50 kg)** (By intravenous infusion): 50-100 mg/kg once daily (max. per dose 4 g), doses at the higher end of the recommended range used in severe cases.
- **Child 9-11 years (body-weight 50 kg and above)** (By intravenous infusion): 2 g once daily.
- **Child 12-17 years** (By intravenous infusion): 2 g once daily.
- **Child 9-11 years (body-weight 50 kg and above)** (By intravenous injection): 2 g once daily.
- **Child 12-17 years** (By intravenous injection): 2 g once daily.
- **Child 1 month-11 years (body-weight up to 50 kg)** (By deep intramuscular injection): 50-100 mg/kg daily, doses at the higher end of the recommended range used in severe cases; maximum 4 g per day.
- **Child 9-11 years (body-weight 50 kg and above)** (By deep intramuscular injection): 2 g once daily.
- **Child 12-17 years** (By deep intramuscular injection): 2 g once daily.
**Suspected bacterial infection in neutropenic patients for ceftriaxone**
- **Neonate up to 15 days** (By intravenous infusion): 20-50 mg/kg once daily, doses at the higher end of the recommended range used in severe cases.
- **Neonate 15 days to 28 days** (By intravenous infusion): 50-100 mg/kg once daily, doses at the higher end of the recommended range used in severe cases.
- **Child 1 month-11 years (body-weight up to 50 kg)** (By intravenous infusion): 50-100 mg/kg once daily (max. per dose 4 g), doses at the higher end of the recommended range used in severe cases.
- **Child 9-11 years (body-weight 50 kg and above)** (By intravenous infusion): 2-4 g once daily, doses at the higher end of the recommended range used in severe cases.
- **Child 12-17 years** (By intravenous infusion): 2-4 g once daily, doses at the higher end of the recommended range used in severe cases.
- **Child 9-11 years (body-weight 50 kg and above)** (By intravenous injection): 2-4 g once daily, doses at the higher end of the recommended range used in severe cases; doses of 50 mg/kg or more should be given by infusion.
- **Child 12-17 years** (By intravenous injection): 2-4 g once daily, doses at the higher end of the recommended range used in severe cases.
- **Child 1 month-11 years (body-weight up to 50 kg)** (By deep intramuscular injection): 50-100 mg/kg daily, doses at the higher end of the recommended range used in severe cases; maximum 4 g per day.
- **Child 9-11 years (body-weight 50 kg and above)** (By deep intramuscular injection): 2 g once daily, increased if necessary up to 4 g daily in 2 divided doses, doses at the higher end of the recommended range used in severe cases.
- **Child 12-17 years** (By deep intramuscular injection): 2 g once daily, increased if necessary up to 4 g daily in 2 divided doses, doses at the higher end of the recommended range used in severe cases.
**Suspected meningococcal disease [pre-hospital treatment], Suspected bacterial meningitis [pre-hospital treatment where there is likely to be a clinically significant delay in transfer to hospital] for ceftriaxone**
- **Child 1 month** (By deep intramuscular injection): 250 mg for 1 dose, administer prior to urgent transfer to hospital unless this will delay transfer. The actual dose given should be communicated to the receiving hospital, where the childs weight should be obtained as soon as possible and the remainder of the dose given if necessary (see dosing for Bacterial meningitis and Meningococcal disease).
- **Child 2-11 months** (By deep intramuscular injection): 500 mg for 1 dose, administer prior to urgent transfer to hospital unless this will delay transfer. The actual dose given should be communicated to the receiving hospital, where the childs weight should be obtained as soon as possible and the remainder of the dose given if necessary (see dosing for Bacterial meningitis and Meningococcal disease).
- **Child 1-4 years** (By deep intramuscular injection): 1 g for 1 dose, administer prior to urgent transfer to hospital unless this will delay transfer. The actual dose given should be communicated to the receiving hospital, where the childs weight should be obtained as soon as possible and the remainder of the dose given if necessary (see dosing for Bacterial meningitis and Meningococcal disease).
- **Child 5-8 years** (By deep intramuscular injection): 1.5 g for 1 dose, administer prior to urgent transfer to hospital unless this will delay transfer. The actual dose given should be communicated to the receiving hospital, where the childs weight should be obtained as soon as possible and the remainder of the dose given if necessary (see dosing for Bacterial meningitis and Meningococcal disease).
- **Child 9-11 years** (By deep intramuscular injection): 2 g for 1 dose, administer prior to urgent transfer to hospital unless this will delay transfer. The actual dose given should be communicated to the receiving hospital, where the childs weight should be obtained as soon as possible and the remainder of the dose given if necessary (see dosing for Bacterial meningitis and Meningococcal disease).
- **Child 12-17 years** (By intravenous injection, or by deep intramuscular injection): 2 g for 1 dose, administer prior to urgent transfer to hospital unless this will delay transfer.
**Bacterial meningitis, Meningococcal disease for ceftriaxone**
- **Neonate up to 15 days** (By intravenous infusion): 50 mg/kg once daily.
- **Neonate 15 days to 28 days** (By intravenous infusion): 100 mg/kg once daily.
- **Child 1 month-11 years (body-weight up to 50 kg)** (By intravenous infusion): 100 mg/kg once daily (max. per dose 4 g), if the total daily dose exceeds 2 g consider giving in 2 divided doses.
- **Child 9-11 years (body-weight 50 kg and above)** (By intravenous infusion): 2 g every 12 hours, alternatively 4 g once daily.
- **Child 12-17 years** (By intravenous infusion): 2 g every 12 hours, alternatively 4 g once daily.
- **Child 9-11 years (body-weight 50 kg and above)** (By intravenous injection): 2 g every 12 hours, alternatively 4 g once daily, doses of 50 mg/kg or more should be given by intravenous infusion.
- **Child 12-17 years** (By intravenous injection): 2 g every 12 hours, alternatively 4 g once daily.
**Bacterial endocarditis for ceftriaxone**
- **Neonate up to 15 days** (By intravenous infusion): 50 mg/kg once daily.
- **Neonate 15 days to 28 days** (By intravenous infusion): 100 mg/kg once daily.
- **Child 1 month-11 years (body-weight up to 50 kg)** (By intravenous infusion): 100 mg/kg once daily (max. per dose 4 g).
- **Child 9-11 years (body-weight 50 kg and above)** (By intravenous infusion): 2-4 g once daily, doses at the higher end of the recommended range used in severe cases.
- **Child 12-17 years** (By intravenous infusion): 2-4 g once daily, doses at the higher end of the recommended range used in severe cases.
- **Child 9-11 years (body-weight 50 kg and above)** (By intravenous injection): 2-4 g once daily, doses at the higher end of the recommended range used in severe cases; doses of 50 mg/kg or more should be given by infusion.
- **Child 12-17 years** (By intravenous injection): 2-4 g once daily, doses at the higher end of the recommended range used in severe cases.
- **Child 1 month-11 years (body-weight up to 50 kg)** (By deep intramuscular injection): 100 mg/kg daily; maximum 4 g per day.
- **Child 9-11 years (body-weight 50 kg and above)** (By deep intramuscular injection): 2 g once daily, increased if necessary up to 4 g daily in 2 divided doses, doses at the higher end of the recommended range used in severe cases.
- **Child 12-17 years** (By deep intramuscular injection): 2 g once daily, increased if necessary up to 4 g daily in 2 divided doses, doses at the higher end of the recommended range used in severe cases.
**Surgical prophylaxis for ceftriaxone**
- **Neonate up to 15 days** (By intravenous infusion): 20-50 mg/kg for 1 dose, dose to be administered 30-90 minutes before procedure.
- **Neonate 15 days to 28 days** (By intravenous infusion): 50-80 mg/kg for 1 dose, dose to be administered 30-90 minutes before procedure.
- **Child 1 month-11 years (body-weight up to 50 kg)** (By intravenous infusion): 50-80 mg/kg for 1 dose (max. per dose 2 g), dose to be administered 30-90 minutes before procedure.
- **Child 9-11 years (body-weight 50 kg and above)** (By intravenous infusion): 2 g for 1 dose, dose to be administered 30-90 minutes before procedure.
- **Child 12-17 years** (By intravenous infusion): 2 g for 1 dose, dose to be administered 30-90 minutes before procedure.
- **Child 9-11 years (body-weight 50 kg and above)** (By intravenous injection): 2 g for 1 dose, dose to be administered 30-90 minutes before procedure.
- **Child 12-17 years** (By intravenous injection): 2 g for 1 dose, dose to be administered 30-90 minutes before procedure.
- **Child 1 month-11 years (body-weight up to 50 kg)** (By deep intramuscular injection): 50-80 mg/kg for 1 dose (max. per dose 2 g), dose to be administered 30-90 minutes before procedure.
- **Child 9-11 years (body-weight 50 kg and above)** (By deep intramuscular injection): 2 g for 1 dose, dose to be administered 30-90 minutes before procedure.
- **Child 12-17 years** (By deep intramuscular injection): 2 g for 1 dose, dose to be administered 30-90 minutes before procedure.
**Pelvic inflammatory disease for ceftriaxone**
- **Child 12-17 years (body-weight 45 kg and above)** (By deep intramuscular injection): 1 g for 1 dose.
**Uncomplicated gonorrhoea [anogenital and pharyngeal infection] for ceftriaxone**
- **Child 12-17 years (body-weight 45 kg and above)** (By deep intramuscular injection): 1 g for 1 dose.
**Gonococcal conjunctivitis for ceftriaxone**
- **Child 12-17 years (body-weight 45 kg and above)** (By deep intramuscular injection): 1 g for 1 dose.
**Gonococcal epididymo-orchitis for ceftriaxone**
- **Child 12-17 years (body-weight 45 kg and above)** (By deep intramuscular injection): 1 g for 1 dose, to be followed by an additional antibacterial course to treat epididymo-orchitis.
**Disseminated gonococcal infection for ceftriaxone**
- **Child 12-17 years (body-weight 45 kg and above)** (By deep intramuscular injection, or by intravenous infusion, or by intravenous injection): 1 g every 24 hours.
**Disseminated gonococcal infection [arthritis and arthritis-dermatitis syndrome] for ceftriaxone**
- **Child 12-17 years (body-weight 45 kg and above)** (By deep intramuscular injection, or by intravenous infusion, or by intravenous injection): 1 g every 24 hours for 7 days, may be switched 24-48 hours after symptoms improve to a suitable oral antibacterial.
**Disseminated gonococcal infection [gonococcal meningitis] for ceftriaxone**
- **Child 12-17 years (body-weight 45 kg and above)** (By intravenous infusion, or by intravenous injection): 1-2 g every 12-24 hours for 10-14 days.
**Disseminated gonococcal infection [gonococcal endocarditis] for ceftriaxone**
- **Child 12-17 years (body-weight 45 kg and above)** (By intravenous infusion, or by intravenous injection): 1-2 g every 12-24 hours for at least 4 weeks.
**Syphilis for ceftriaxone**
- **Child 12-17 years (body-weight 50 kg and above)** (By intravenous infusion, or by intravenous injection, or by deep intramuscular injection): 0.5-1 g once daily for 10-14 days, dose increased to 2 g once daily for neurosyphilis.
**Disseminated Lyme borreliosis (early [Stage II] and late [Stage III]) (administered on expert advice) for ceftriaxone**
- **Neonate 15 days to 28 days** (By intravenous infusion): 50-80 mg/kg once daily for 14-21 days, the recommended treatment durations vary and national or local guidelines should be taken into consideration.
**Lyme disease [affecting central nervous system] for ceftriaxone**
- **Child 1 month-11 years (administered on expert advice) (body-weight up to 50 kg)** (By intravenous infusion): 80 mg/kg once daily for 21 days.
- **Child 1 month-11 years (administered on expert advice) (body-weight 50 kg and above)** (By intravenous infusion): 2 g twice daily for 21 days, alternatively 4 g once daily for 21 days.
- **Child 12-17 years (administered on expert advice)** (By intravenous infusion): 2 g twice daily for 21 days, alternatively 4 g once daily for 21 days.
- **Child 1 month-11 years (administered on expert advice) (body-weight 50 kg and above)** (By intravenous injection): 2 g twice daily for 21 days.
- **Child 12-17 years (administered on expert advice)** (By intravenous injection): 2 g twice daily for 21 days, alternatively 4 g once daily for 21 days.
**Lyme arthritis, Acrodermatitis chronica atrophicans for ceftriaxone**
- **Child 1 month-11 years (administered on expert advice) (body-weight up to 50 kg)** (By intravenous infusion): 80 mg/kg once daily (max. per dose 2 g) for 28 days.
- **Child 1 month-11 years (administered on expert advice) (body-weight 50 kg and above)** (By intravenous infusion, or by intravenous injection): 2 g once daily for 28 days.
- **Child 12-17 years (administered on expert advice)** (By intravenous infusion, or by intravenous injection): 2 g once daily for 28 days.
**Lyme carditis for ceftriaxone**
- **Child 1 month-11 years (administered on expert advice) (body-weight up to 50 kg)** (By intravenous infusion): 80 mg/kg once daily (max. per dose 2 g) for 21 days.
- **Child 1 month-11 years (administered on expert advice) (body-weight 50 kg and above)** (By intravenous infusion, or by intravenous injection): 2 g once daily for 21 days.
- **Child 12-17 years (administered on expert advice)** (By intravenous infusion, or by intravenous injection): 2 g once daily for 21 days.
**Prevention of secondary case of meningococcal meningitis for ceftriaxone**
- **Child 1 month-11 years** (By deep intramuscular injection): 125 mg for 1 dose.
- **Child 12-17 years** (By deep intramuscular injection): 250 mg for 1 dose.
**Prevention of secondary case of Haemophilus influenzae type b disease for ceftriaxone**
- **Child 1 month-11 years** (By intravenous infusion): 50 mg/kg once daily (max. per dose 1 g) for 2 days.
- **Child 12-17 years** (By deep intramuscular injection, or by intravenous injection, or by intravenous infusion): 1 g once daily for 2 days.
**Acute otitis media for ceftriaxone**
- **Child 1 month-11 years (body-weight up to 50 kg)** (By deep intramuscular injection): 50 mg/kg for 1 dose (max. per dose 2 g), dose can be given for 3 days if severely ill or previous therapy failed.
- **Child 9-11 years (body-weight 50 kg and above)** (By deep intramuscular injection): 1-2 g for 1 dose, dose can be given for 3 days if severely ill or previous therapy failed.
- **Child 12-17 years** (By deep intramuscular injection): 1-2 g for 1 dose, dose can be given for 3 days if severely ill or previous therapy failed.
Cautions
General cautions: History of hypercalciuria; history of kidney stones Specific cautions: With intravenous use Concomitant treatment with intravenous calcium (including total parenteral nutrition containing calcium)
Side effects
Common or very common Abdominal pain; diarrhoea; dizziness; eosinophilia; headache; leucopenia; nausea; neutropenia; pseudomembranous enterocolitis; skin reactions; thrombocytopenia; vomiting Uncommon Anaphylactic reaction; angioedema Rare or very rare Agranulocytosis; haemolytic anaemia; nephritis tubulointerstitial (reversible); severe cutaneous adverse reactions (SCARs) Side-effects For ceftriaxone Uncommon Anaemia; coagulation disorder; fungal infection Rare or very rare Bronchospasm; glycosuria; haematuria; oedema Frequency not known Antibiotic associated colitis; cholelithiasis; hypersensitivity; nephrolithiasis; oral disorders; pancreatitis; seizure; vertigo Side-effects, further information Precipitates of calcium ceftriaxone can occur in the gall bladder and urine (particularly in very young, dehydrated or those who are immobilised)-consider discontinuation if symptomatic.
Interactions
**Other interactions (4):**
- For interaction between calcium containing products and ceftriaxone, please see sections 4.4 above.
- Physical incompatibilities including interaction with ceftriaxone and sodium bicarbonate See section 4.4 and section 6.2.
- Ceftriaxone : See sections 4.3 and 4.4 for more information Drugs leading to an increased vasopressin effect The below listed drugs increase the vasopressin effect, leading to reduced renal...
- Cephalosporins: Some cephalosporins, e.g.
Pregnancy
Manufacturer advises use only if benefit outweighs risk-limited data available but not known to be harmful in animal studies. Specialist sources indicate suitable for use in pregnancy. D
Breast feeding
Specialist sources advise ceftriaxone is compatible with breastfeeding-present in milk in low concentration but limited effects to breast-fed infant. D
Hepatic impairment
Manufacturer advises caution in severe impairment (no information available).
Renal impairment
Dose adjustments See Prescribing in renal impairment . Manufacturer advises a dose reduction may be required in severe renal impairment in combination with hepatic impairment (limited information available)-monitor for efficacy. In adults: Manufacturer advises max. 2 g daily if creatinine clearance less than 10 mL/minute. In children: Expert sources advise max. 50 mg/kg daily or max. 2 g daily if estimated glomerular filtration rate less than 10 mL/minute/1.73 m 2 .
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Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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