Infectious Disease Compendium

Ceftriaxone (Rocephin®)

Dosing

CrCl Formula

CrCl > 80: 1 - 2 g iv q 12 - 24 h.

CrCl 80-50: 1 - 2 g iv q 12 - 24 h.

CrCl 50-10: 1 - 2 g iv q 12 - 24 h.

CrCl < 10: 1 - 2 g iv q 12 - 24 h

Hemodialysis: supposedly no change, but long term consider 1 gm q d to avoid neurotoxicity.

"As CTRX is excreted via both biliary and renal excretion, patients with renal failure require no adjustment in dosage. However, in cases of ESRD, delayed clearance of CTRX has been reported. Simon et al. recommended CTRX 2 g i.v. after each dialysis session only in maintenance hemodialysis patients. We believe that CTRX accumulation in ESRD is not well recognized, as all attending doctors in our cases were not aware of it (PubMed)."

Peritoneal dialysis:

Obesity dosing

Important side effects

Cholestatic hepatitis and the formation of ceftriaxone gall stones, the worlds most expensive. Usually seen at high doses.  Also, much more rarely, renal stones (PubMed).

Important drug interactions

Increases cyclosporine levels.

QT prolongation when combined with lansoprazole.

When combined with intravenous calcium in neonates it can lead to death. The importance of this reaction in adults is not known as of 10/3/7, but it always shows up as an annoying EMR warning.

Rants and Screeds

I wonder which is more expensive: ceftriaxone gallstones or Crixivan kidney stones?

Pearls

Treatment of choice

N. gonorrhoea.

Use for

Abdominal hysterectomy, Arthritis, Bronchitis, Brucella infections, Cellulitis, Brucella, Cystic fibrosis, Endocarditis, endocervical Gonorrhea, Epididymitis, Escherichia coli infections, Gonorrhea, Haemophilus influenzae infections and nasopharyngeal carriers, intra-abdominal infections, Intraabdominal infections, Lyme Disease, Meningitis, Moraxella catarrhalis infections, Neisseria meningitidis pharyngeal carriers, Neutropenic fever, Osteomyelitis, Otitis media, Peritonitis, PID, Pneumonia, Proctitis, Proteus, Providencia stuartii infections, Relapsing Fever, Salmonella infections, Sepsis, Serratia infections, sexual assault, Shigella infections, shunt infections, surgical prophylaxis, syphilis, Typhoid fever, UTI, vaginal hysterectomy.

Don't use for

Pseudomonas and its ilk. S. aureus.

Class

Third-generation cephalosporin.

Curious Cases

Relevant links to my Medscape blog

Neurotoxic Accumulation

Last Update: 11/03/19.