CEFTRIAXONE Rocephin CLASSIFICATION(S): Ther. Class: anti-infectives Pharm.

Class: third-generation cephalosporins INDICATIONS Treatment of: o Skin and skin structure infections o Septicemia o Bone and joint infections o Meningitis o Urinary and gynecologic infections including o Perioperative prophylaxis gonorrhea or respiratory tract infections o Single-dose treatment of acute bacterial otitis media o Intra-abdominal infections o Lyme disease. ACTION Bind to the bacterial cell wall membrane, causing cell death. Therapeutic Effects: o Bactericidal action against susceptible bacteria. Spectrum: o Similar to that of second-generation cephalosporins, but activity against staphylococci is less, whereas activity against gram-negative pathogens is greater, even for organisms resistant to first- and second-generation agents o Notable is increased action against o Enterobacter o Klebsiella o Serratia o Haemophilus pneumoniae o Moraxella influenzae o Neisseria catarrhalis o Escherichia coli o Proteus o Borrelia o Providencia burgdorferi o Some activity against anaerobes, including Bacteroides fragilis. PHARMACOKINETICS Absorption: Well absorbed after IM administration.

Distribution: Widely distributed. Cross the placenta; enter breast milk in low concentrations. CSF penetration better than with first- and second-generation agents. Protein Binding: 90%. Metabolism and Excretion: Partly metabolized and partly excreted in the urine. Half-life: ceftriaxone348522 min CONTRAINDICATIONS AND PRECAUTIONS Contraindicated in: Hypersensitivity to cephalosporins Serious hypersensitivity to penicillins Use Cautiously in: Combined severe hepatic and renal impairment (dosage reduction/increased dosing interval recommended for ceftriaxone) History of GI disease, especially colitis Geriatric patients (dosage adjustment due to age-related decrease in renal function may be necessary) Pregnancy and lactation (have been used safely). ADVERSE REACTIONS AND SIDE EFFECTS* *CAPITALS indicate life threatening; underlines indicate most frequent. CNS: SEIZURES(high doses). GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea, vomiting, cramps, pseudolithiasis (ceftriaxone). Derm: rashes, urticaria. Hemat: bleeding (increased with cefoperazone), blood dyscrasias, hemolytic anemia. Local: painat IM site, phlebitisat IV site. Misc: allergic reactions includingANAPHYLAXIS andSERUM SICKNESS, superinfection. INTERACTIONS Drug-Drug: Ingestion of alcohol within 4872 hr of cefoperazone may result in a disulfiram-like reaction Concurrent use of large doses of cephalosporins and NSAIDs may increase the risk of bleeding Concurrent use of loop diuretics ornephrotoxic agents including aminoglycosidesmay increase the risk of nephrotoxicity ROUTE AND DOSAGE

Ceftriaxone IM, IV (Adults): Most infections0.51 g q 12 hr or 12 g q 24 hr. Gonorrhea250 mg IM. Meningitis2 g q 12 hr. IM, IV (Children): Most infections2537.5 mg/kg q 12 hr. Meningitis100 mg/kg q 24 hr or 50 mg/kg q 12 hr. Skin/softtissue infections5075 mg/kg q 24 hr. Acute otitis media50 mg/kg IM single dose. AVAILABILITY o Ceftriaxone Powder for injection: 250 mgRx, 500 mgRx, 1 gRx, 2 gRx, 10 gRx Premixed containers: 1 g/50 mlRx, 2 g/50 mlRx. TIME/ACTION PROFILE ONSET Ceftriaxone IM Ceftriaxone IV rapid rapid PEAK 12 hr end of infusion DURATION 1224 hr 1224 hr

NURSING IMPLICATIONS ASSESSMENT Assess patient for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy. Before initiating therapy, obtain a history to determine previous use of and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic response. Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results. Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify the physician or other health care professional immediately if these symptoms occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction. Lab Test Considerations: May cause positive results for Coombs' test in patients receiving high doses or in neonates whose mothers were given cephalosporins before delivery. o May cause increased serum AST, ALT, alkaline phosphatase, bilirubin, LDH, BUN, and creatinine.

May rarely cause leukopenia, neutropenia, agranulocytosis, thrombocytopenia, eosinophilia, lymphocytosis, and thrombocytosis. POTENTIAL NURSING DIAGNOSES Infection, risk for (Indications, Side Effects). Diarrhea (Adverse Reactions). Knowledge deficit, related to medication regimen (Patient/Family Teaching). IMPLEMENTATION o PO: Administer around the clock. May be administered on full or empty stomach. Administration with food may minimize GI irritation. Shake oral suspension well before administering. IM: Reconstitute IM doses with sterile or bacteriostatic water for injection or 0.9% NaCl for injection. May be diluted with lidocaine to minimize injection discomfort. o Inject deep into a well-developed muscle mass; massage well. IV: Monitor injection site frequently for phlebitis (pain, redness, swelling). Change sites every 4872 hr to prevent phlebitis. o If aminoglycosides are administered concurrently, administer in separate sites, if possible, at least 1 hr apart. If second site is unavailable, flush lines between medications. Direct IV: Dilute in at least 1 g/10 ml. Avoid direct IV administration of ceftriaxone. Do not use preparations containing benzyl alcohol for neonates. Rate: Administer slowly over 35 min. Ceftriaxone Intermittent Infusion: Reconstitute each 250-mg vial with 2.4 ml, each 500-mg vial with 4.8 ml, each 1-g vial with 9.6 ml, and each 2-g vial with 19.2 ml of sterile water for injection, 0.9% NaCl, or D5W for a concentration of 100 mg/ml. Solution may be further diluted in 50100 ml of 0.9% NaCl, D5W, D10W, D5/0.45% NaCl, or LR. Solution may appear light yellow to amber. Solution is stable for 3 days at room temperature. Rate: Administer over 1530 min in adults and 1030 min in newborns or children. Y-Site Compatibility: o acyclovir o aztreonam o foscarnet o heparin o allopurinol o diltiazem o gatifloxacin o linezolid o amifostine o fludarabine o granisetron o melphalan

o o o o

meperidine methotrexate morphine paclitaxel

o o o

propofol remifentanil sargramostim

o o o

sodium bicarbonate tacrolimus teniposide

o o o

theophylline thiotepa zidovudine

Y-Site Incompatibility: o alatrovafloxacin o fluconazole o pentamidine o vinorelbine. o filgrastim o labetalol o vancomycin PATIENT/FAMILY TEACHING Instruct patient to take medication at evenly spaced times and to finish the medication completely, even if feeling better. Missed doses should be taken as soon as possible unless almost time for next dose; do not double doses. Advise patient that sharing of this medication may be dangerous. Advise patient to report signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foulsmelling stools) and allergy. Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional. Cefditoren: Inform female patients that cefditoren can be taken concomitantly with hormonal contraceptives. EVALUATION Clinical response to therapy can be evaluated by: Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection Decreased incidence of infection when used for prophylaxis.