Ceftriaxone: instructions for using injections

Pharmacodynamics and pharmacokinetics

What is Ceftriaxone?

According to Wikipedia, ceftriaxone is an antibiotic whose bactericidal effect is due to its ability to disrupt the synthesis of peptidoglycan in bacterial cell walls.

Pharmacodynamics

A universal antibacterial agent, the mechanism of action of which is determined by the ability to suppress the synthesis of the bacterial cell wall. The drug exhibits greater resistance to most β-lactamases of gram(+) and gram(-) microorganisms.

Active regarding:

• Gram(+) aerobes - St. aureus (including penicillinase-producing strains) and Epidermidis, Streptococcus (pneumoniae, pyogenes, viridans group);
• Gram(-) aerobes - Enterobacter aerogenes and cloacae, Acinetobacter calcoaceticus, Haemophilus influenzae (including penicillinase-producing strains) and parainfluenzae, Borrelia burgdorferi, Klebsiella spp. (including pneumoniae), Escherichia coli, Moraxella catarrhalis and diplococci of the genus Neisseria (including penicillinase-producing strains), Morganella morganii, Proteus vulgaris and Proteus mirabilis, Neisseria meningitidis, Serratia spp., some strains of Pseudomonas aeruginosa;
• anaerobes - Clostridium spp. (exception: Clostridium difficile), Bacteroides fragilis, Peptostreptococcus spp..

In vitro (clinical significance remains unknown) activity is observed against strains of the following bacteria: Citrobacter diversus and freundii, Salmonella spp. (including against Salmonella typhi), Providencia spp. (including in relation to Providencia rettgeri), Shigella spp.; Bacteroides bivius, Streptococcus agalactiae, Bacteroides melaninogenicus.

Methicillin -resistant Staphylococcus, many strains of Enterococcus (including Str. faecalis) and group D Streptococcus are resistant to cephalosporin antibiotics (including ceftriaxone).

Pharmacokinetics

• bioavailability - 100%;
• T Cmax when Ceftriaxone is administered intravenously - at the end of the infusion, when administered intramuscularly - 2-3 hours;
• connection with plasma proteins - from 83 to 96%;
• T1/2 with intramuscular administration - from 5.8 to 8.7 hours, with intravenous administration - from 4.3 to 15.7 hours (depending on the disease, the patient’s age and the condition of his kidneys).

In adults, the concentration of ceftriaxone in the cerebrospinal fluid when administered 50 mg/kg after 2-24 hours is many times higher than the MIC (minimum inhibitory concentration) for the most common pathogens of meningococcal infection . The drug penetrates well into the cerebrospinal fluid during inflammation of the meninges.

Ceftriaxone is excreted unchanged:

• kidneys - by 33-67% (in newborn babies this figure is 70%);
• with bile into the intestines (where the drug is inactivated) - by 40-50%.

Hemodialysis is ineffective.

Indications for use of Ceftriaxone

The annotation states that the indications for the use of Ceftriaxone are infections caused by bacteria sensitive to the drug. Intravenous infusions and injections of medications are prescribed to treat:

• infections of the abdominal cavity (including empyema of the gallbladder , angiocholitis , peritonitis ), ENT organs and respiratory tract ( empyema of the pleura , pneumonia , bronchitis , lung abscess , etc.), bone and joint tissue, soft tissues and skin, urogenital tract (including pyelonephritis , pyelitis , prostatitis , cystitis , epididymitis );
• epiglottitis;
• infected burns/wounds;
• infectious lesions of the maxillofacial area;
• bacterial septicemia;
• sepsis;
• bacterial endocarditis;
• bacterial meningitis;
• syphilis;
• chancroid;
• tick-borne borreliosis (Lyme disease);
• uncomplicated gonorrhea (including in cases where the disease is caused by microorganisms that secrete penicillinase);
• salmonellosis/salmonella carriage;
• typhoid fever.

The drug is also used for perioperative prophylaxis and for the treatment of immunocompromised patients.

What is Ceftriaxone used for for syphilis?

Although Penicillin is the drug of choice of syphilis , its effectiveness may be limited in some cases.

The use of cephalosporin antibiotics is resorted to as a backup option in case of intolerance to drugs of the penicillin group.

The valuable properties of the drug are:

• the presence in its composition of chemical substances that have the ability to suppress the formation of cell membranes and mucopeptide synthesis in the walls of bacterial cells;
• the ability to quickly penetrate organs, fluids and tissues of the body and, in particular, into the cerebrospinal fluid, which in patients with syphilis undergoes many specific changes;
• Possibility of use for the treatment of pregnant women.

The medicine is most effective in cases where the causative agent of the disease is Treponema pallidum, since the distinctive feature of Ceftriaxone is its high treponemocidal activity. The positive effect is especially pronounced with intramuscular administration of the drug.

Treatment of syphilis with the use of the drug gives good results not only in the early stages of the disease, but also in advanced cases: with neurosyphilis , as well as with secondary and latent syphilis.

Since T1/2 of Ceftriaxone is approximately 8 hours, the drug can be used equally successfully in both inpatient and outpatient treatment regimens. It is enough to administer the drug to the patient once a day.

For preventive treatment, the drug is administered over 5 days, for primary syphilis - a 10-day course, early latent and secondary syphilis are treated within 3 weeks.

For non-advanced forms of neurosyphilis, the patient is administered a single dose of 1-2 g of Ceftriaxone for 20 days; in the later stages of the disease, the drug is administered at a dose of 1 g/day. for 3 weeks, after which an interval of 14 days is maintained and treatment with a similar dosage is carried out for 10 days.

For acute generalized meningitis and syphilitic meningoencephalitis, the dose is increased to 5 g/day.

Ceftriaxone injections: why is the drug prescribed for angina in adults and children?

Despite the fact that the antibiotic is effective for various lesions of the nasopharynx (including sore throat and sinusitis ), it is, as a rule, rarely used as a drug of choice, especially in pediatrics.

For angina, the medicine can be administered through a dropper into a vein or in the form of regular injections into the muscle. However, in the vast majority of cases, the patient is prescribed intramuscular injections. The solution is prepared immediately before use. The finished mixture remains stable at room temperature for 6 hours after preparation.

For children with angina, Ceftriaxone is prescribed in exceptional cases when acute angina is complicated by severe suppuration and inflammation.

The appropriate dosage is determined by the attending physician.

During pregnancy, the drug is prescribed in cases where penicillin antibiotics are not effective. Although the medicine crosses the placental barrier, it does not have a significant effect on the health and development of the fetus.

Treatment of sinusitis with Ceftriaxone

For sinusitis, antibacterial agents are first-line drugs. Completely penetrating the blood, Ceftriaxone is retained at the site of inflammation in the required concentrations.

As a rule, the medicine is prescribed in combination with mucolytics , vasoconstrictors , etc.

How to inject the drug for sinusitis? Typically, the patient is prescribed Ceftriaxone to be injected into the muscle twice a day, 0.5-1 g. Before injection, the powder is mixed with Lidocaine (it is preferable to use a one percent solution) or d/i water.

Treatment lasts at least 1 week.

Negative sides

In modern society, there is a stereotype that treatment with injections is much more productive and will give the desired result faster, however, in most cases this is not the case. Nowadays there are enough drugs used orally, which are in no way inferior to treatment with injections. I would like to draw attention to the disadvantages of using the injection method.

• Everything related to injections causes hostility, pain, and fear.
• If sterility is violated, an infection transmitted only through blood, for example, viral hepatitis B and AIDS, can be introduced into the body.
• Complications can be caused by incorrect insertion; the needle may accidentally hit a nerve, which can lead to complex consequences.
• There are cases when, after the injection, the tissue at the injection site turns red, becomes painful, and in the worst case, an abscess may occur that will need to be opened.
• When given an injection, allergic reactions are more acute than when using the same drug orally in capsules or tablets. When administering injections, the possibility of anaphylactic shock is several times higher than in other cases.

Experts around the world strive to limit the number of injections . The best pharmacologists from leading companies see their task as creating drugs that act quickly and effectively when taken orally. It is unlikely that it will be possible to completely abandon injections, especially when treating emergency conditions, but minimizing the number and limiting the indications is a completely feasible task.

Positive sides

• Injections are effective in cases where rapid penetration of the drug into the blood and an immediate therapeutic effect are necessary.
• Injections are used when the drug cannot be administered through the oral cavity, as it will be destroyed in the gastrointestinal tract.
• It is impossible to drink the medication, for example, if you are unconscious or vomiting.
• The drug used, when administered by syringe, has a more pronounced and longer-lasting effect.

Technical side

Everyone in their life has been faced with the need to give themselves or loved ones a simple intramuscular injection. It's quite simple if you know how to do it and don't be afraid. The recommendations written below apply specifically to intramuscular injections, but it is better to entrust intravenous injections to people with medical education and not risk doing it yourself.

1. Be sure to wash your hands with soap.
2. Next, check the expiration date of the drug that needs to be administered.
3. Taking the ampoule, shake it, lightly tap the tip with your fingernail so that no liquid remains in it, wipe the tip with a cotton swab moistened with alcohol.
4. Then you need to open the ampoule with the medicine; to do this, remove the ampoule file from the cardboard box with the medicine. Taking the file, run it forcefully along the base of the tip several times, and then carefully break it off.
5. Unpack the syringe without removing the cap from the needle and put it on the syringe.
6. Carefully, without touching the needle, remove the plastic cap from it and draw up the medicine.
7. Turn the syringe vertically up, and, holding it in this light position, tap it with your fingernail so that the air bubbles rise to the top.
8. Press lightly to release air from the syringe; when a drop of medicine appears at the tip of the needle, stop.
9. Place a cap on the needle.
10. Place the patient on their stomach or side to relax the butt muscles.
11. Mentally divide the buttock into four squares, the injection is made in the upper outer square.
12. The place where the injection will be given must be wiped with a cotton swab dipped in an alcohol solution.
13. To reduce pain, the skin at the injection site can be stretched or squeezed with the fingers of the other hand. In children, the skin should not be stretched under any circumstances; it should be compressed.
14. With a sharp movement at a right angle, insert the needle 3/4 of the way through, that is, almost to the very end.
15. Gradually, slowly, introduce the medicine.
16. With a sharp movement, remove the needle and press the injection site with cotton wool moistened with alcohol.
17. Massage the affected muscle.

If possible, limit the number of injections in one place; it is advisable not to inject in one area more than 2 times a week. To do this, alternate sides: on the first day, inject into the right side, on the second, into the left.

In addition, you may encounter the fact that the injection medicine is in powder form. In this case, you need to dilute it with special distilled water or novocaine in ampoules. To dilute the medicine you will need one syringe and two needles.

How to properly dilute powdered medicine

1. Take an ampoule with liquid, it can be distilled water or novocaine, and use a needle to draw it into a syringe;
2. Wipe the lid of the bottle with the powder with a cotton swab and alcohol and inject liquid from the syringe into it;
3. Remove the syringe and shake the bottle well until the powder is completely dissolved;
4. Then, draw the solution into the syringe again;
5. Place a new needle on the syringe without removing the cap.
6. The solution for administration is ready.

Contraindications

Ceftriaxone is not prescribed in case of 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.

Side effects of Ceftriaxone

Side effects of the drug appear as:

• hypersensitivity reactions: eosinophilia , fever, itching, urticaria edema , skin rash, multiforme (in some cases malignant) exudative erythema , serum sickness , anaphylactic shock , chills;
• headache and dizziness;
• oliguria;
• dysfunction of the digestive organs: nausea, vomiting, flatulence , taste disturbance, stomatitis , diarrhea , glossitis , formation of sludge in the gallbladder and pseudocholelithiasis , pseudomembranous enterocolitis , dysbacteriosis , candidomycosis and other superinfections;
• hematopoiesis disorders: anemia (including hemolytic ), lymphopenia , leukopenia, neutropenia, thrombocytopenia, granulocytopenia , thrombocytosis and leukocytosis , hematuria , basophilia , nosebleeds).

If the medicine is administered intravenously, inflammation of the venous wall, as well as pain along the vein, is possible. The injection of the drug into the muscle is accompanied by pain at the injection site.

Ceftriaxone (injections and IV infusion) may also affect laboratory parameters. The patient's prothrombin time decreases (or increases), the activity of alkaline phosphatase and liver transaminases increases, as well as the concentration of urea, hypercreatininemia , hyperbilirubinemia , and glycosuria .

Reviews of the side effects of Ceftriaxone allow us to conclude that with intramuscular administration of the drug, almost 100% of patients complain of severe pain from the injection, some report muscle pain, dizziness, chills, weakness, itching and rash.

The injections are easiest to tolerate if you dilute the powder with an anesthetic. In this case, it is necessary to do a test both for the drug itself and for the painkiller.

Instructions for use of Ceftriaxone (Method and dosage)

How to dilute Ceftriaxone for injection?

The manufacturer's instructions, as well as the Vidal reference book, indicate that the drug can be injected into a vein or into a muscle.

Dosage for adults and children over 12 years of age: 1-2 g/day. The antibiotic is administered once or once every 12 hours at half the dose.

In particularly serious cases, as well as if the infection is caused by a pathogen moderately sensitive to Ceftriaxone, the dose is increased to 4 g/day.

For gonorrhea , a single injection of 250 mg of the drug into the muscle is recommended.

For preventive purposes, before an infected or suspected infected operation, depending on the degree of danger of infectious complications, the patient should be administered a single dose of 1-2 g of Ceftriaxone 0.5-1.5 hours before surgery.

For children in the first 2 weeks of life, the medicine is administered 1 time per day. The dose is calculated using the formula 20-50 mg/kg/day. The highest dose is 50 mg/kg (which is due to the underdevelopment of the enzyme system).

The optimal dosage for children under 12 years of age (including infants) is also selected depending on weight. The daily dose varies from 20 to 75 mg/kg. For children weighing more than 50 kg, Ceftriaxone is prescribed in the same dose as for adults.

Doses greater than 50 mg/kg should be administered as an intravenous infusion over at least 30 minutes.

For bacterial meningitis, treatment begins with a single dose of 100 mg/kg/day. The highest dose is 4 g. As soon as the pathogen is isolated and its sensitivity to the drug is determined, the dose is reduced.

Reviews about the drug (in particular, about its use in children) allow us to conclude that the drug is very effective and affordable, but its significant drawback is severe pain at the injection site. As for side effects, according to the patients themselves, there are no more of them than with any other antibiotic.

How many days to inject the drug?

The duration of treatment depends on what pathogenic microflora causes 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 are sensitive to the drug - in 10-14 days.

Ceftriaxone injections, instructions for use. How to dilute the drug?

Lidocaine solution (1 or 2%) or water for injection (d/i).

When using water d/i, it should be taken into account 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 diluting the powder is usually taken in cases where the use of Lidocaine is impossible due to the patient being allergic to it.

The best option is a one percent solution of Lidocaine. It is better to use water as an adjuvant when diluting the drug with Lidocaine 2%.

Is it possible to dilute Novocaine with Ceftriaxone?

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

Based on the reviews of the patients themselves, they note that Lidocaine is better than Novocaine in relieving pain when Ceftriaxone is administered.

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

How to dilute Ceftriaxone with Novocaine?

If Novocain is used as a solvent, it is taken in a volume of 5 ml per 1 g of the drug. If you take a smaller amount of Novocaine, the powder may not completely dissolve, and the syringe needle will become clogged with lumps of medicine.

Dilution with Lidocaine 1%

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

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

The medicine is injected deep into the gluteal muscle (no more than 1 g in each buttock).

The drug diluted with Lidocaine is not intended for intravenous administration. It is allowed to be injected 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 and two percent Lidocaine. To dilute 0.5 g of the drug, also mix 1.8 ml of Lidocaine with 1.8 ml of water, 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.

How to dilute Ceftriaxone for intramuscular administration in children?

This method of intramuscular injection is practically not used in pediatric practice, since Ceftriaxone with Novocaine can cause severe anaphylactic shock in a child, and in combination with Lidocaine, it can contribute to the occurrence of convulsions and disruption of the heart.

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

Dilution 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 carrying out infusion therapy, the drug is administered for at least half an hour. To prepare a solution, 2 g of 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 the antibiotic, when in contact with body tissues, is highly active and severely irritates them.

Doses for animals

The dosage for cats and dogs is selected taking into account the body weight of the animal. As a rule, it is 30-50 mg/kg.

If a 0.5 g bottle is used, 1 ml of two percent Lidocaine and 1 ml of water d/i (or 2 ml of Lidocaine 1%) should be added to it. After vigorously shaking the medicine until the lumps are completely dissolved, it is drawn into a syringe and injected into the muscle or under the skin of the sick animal.

The dosage for a cat (Ceftriaxone 0.5 g is usually used for small animals - cats, kittens, etc.), if the doctor prescribed 40 mg of Ceftriaxone per 1 kg of weight, is 0.16 ml/kg.

For dogs (and other large animals), take bottles of 1 g. The solvent is taken in a volume of 4 ml (2 ml Lidocaine 2% + 2 ml water for injection). For a dog weighing 10 kg, if the dose is 40 mg/kg, you need to administer 1.6 ml of the prepared solution.

If it is necessary to administer Ceftriaxone intravenously through a catheter, sterile distilled water is used for dilution.

Methods of drug administration

The medication is administered in two ways: into a vein or into muscle fibers. Doctors choose an option depending on the disease and the patient’s condition. The effect appears much faster when the medicine is injected into a vein.

The medicine is diluted in different ways:

• lidocaine;

• novocaine;
• water for injections.

Lidocaine is usually used when the drug is administered through a muscle. An anesthetic substance reduces the pain from the injection. When a medication is injected into a vein, it is diluted with saline solution. This method is used if the patient has allergies. The water must be sterile. This is necessary to prevent the penetration of a secondary infection that is resistant to the substance used.

Doctors themselves determine the treatment method, based on the pathogen and the characteristics of the pathology:

• For gonorrhea, 250 g of the drug is prescribed. The injection is performed inside the muscle. The drug is administered once.
• To cure meningitis, the drug is calculated as follows: per 1 kg. 100 mg. medications. More than 4 g should not be prescribed.
• When a positive effect is observed, the dose is reduced. For prophylaxis or before an upcoming operation, 1 - 2 g of the drug is administered.

When the baby turns 14 days old, he can be administered the medication once a day. The dose is calculated as follows: per 1 kg. 20 - 50 mg. Do not use more than 50 mg per day.

For patients under 12 years of age, the dose is determined by weight. The amount of medicine can increase to 75 mg. When a small patient weighs more than 50 kg, he is prescribed the usual dosage. If more than 50 mg/kg is required, administer intravenously. Pour in slowly using a dropper. The procedure lasts from 30 minutes. In this case, the medication is diluted with saline solution.

Typically, lidocaine is used to dilute the drug with water for injections. Divide the composition into 2 parts. The prepared mixture can be stored for no longer than 6 hours.

Children are prohibited from diluting the medication with anesthetics, so as not to cause convulsions and anaphylaxis.

Children are prescribed only Ceftriaxone with water for injection, distilled liquid. The medicine is administered very slowly. This allows the baby to experience a minimum of discomfort. For 1 g of medication take 10 ml.

To give injections to adult patients inside the muscle fibers, use a 4-cc needle. An injection is given in the buttock. The needle is not inserted to the level of the dermis by 2 - 3 mm. More than 1 g of medication is not injected into the muscles.

Interaction

In one volume, it is pharmaceutically incompatible with other antimicrobial agents.

By suppressing intestinal microflora, it prevents the formation of vitamin K . For this reason, the use of the drug in combination with drugs that reduce platelet aggregation (sulfinpyrazone, NSAIDs) may provoke bleeding.

The same feature of Ceftriaxone enhances the effect of anticoagulants when used together.

In combination with loop diuretics, the risk of nephrotoxicity increases.

special instructions

The drug is used in a hospital setting. In patients who are on hemodialysis, as well as with simultaneous severe hepatic and renal failure, plasma concentrations of Ceftriaxone should be kept under control.

With long-term treatment, regular monitoring of the peripheral blood picture and indicators characterizing the function of the kidneys and liver is required.

Sometimes (rarely) an ultrasound of the gallbladder may show shadows that indicate the presence of sediment. The darkening disappears after stopping the course of treatment.

vitamin K in addition to Ceftriaxone .

If there is an imbalance of water and electrolytes, as well as arterial hypertension , the level of sodium in the blood plasma should be monitored. If the treatment is long-term, the patient is advised to undergo a general blood test.

Like other cephalosporins, the drug has the ability to displace bilirubin , and therefore it is used with caution in newborns with hyperbilirubinemia (and, in particular, in premature infants).

The drug does not affect the speed of neuromuscular conduction.

Ceftriaxone

Hypersensitivity reactions

As with other β-lactam antibiotics, severe hypersensitivity reactions, some fatal, have been reported. If a severe hypersensitivity reaction develops, ceftriaxone therapy should be discontinued immediately and appropriate emergency treatment measures taken. Before starting therapy with ceftriaxone, it is necessary to determine whether the patient has had 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).

Sodium content

1.0 g of Ceftriaxone contains 3.6 mmol of sodium. This should be taken into account in patients on a sodium controlled diet.

Hemolytic anemia

As with the use of other cephalosporins, autoimmune hemolytic anemia may develop during treatment with Ceftriaxone. Cases of severe hemolytic anemia have been reported in adults and children, including deaths.

If anemia develops in a patient being treated with ceftriaxone, the diagnosis of cephalosporin-associated anemia cannot be excluded and treatment must be discontinued until the cause is determined.

Diarrhea caused by Clostridium difficile

As with the use of most other antibacterial drugs, cases of diarrhea caused by Clostridium difficile (C. difficile) have been reported during treatment with ceftriaxone.

varying severity: from mild diarrhea to fatal colitis.

Treatment with antibacterial drugs suppresses the normal microflora of the colon and provokes the growth of C. difficile

.
In turn, C. difficile
produces toxins A and B, which are factors in the pathogenesis of diarrhea caused by
C. difficile.
strains
of C. difficile
are infectious agents with a high risk of morbidity and mortality due to possible resistance to antimicrobial therapy, and treatment may require colectomy.
C. difficile
diarrhea in all patients with diarrhea after antibiotic therapy.
A thorough medical history is necessary, since there have been cases of diarrhea caused by C. difficile
more than 2 months after antibiotic therapy.
C. difficile
diarrhea is suspected or confirmed current non-
C. difficile
antibiotic therapy may need to be discontinued.
In accordance with clinical indications, appropriate treatment should be prescribed with the administration of fluids and electrolytes, proteins, antibiotic therapy for C. difficile
, and surgical treatment. Do not use medications that inhibit intestinal motility.

Superinfections

As with treatment with other antibacterial drugs, superinfections may develop.

Changes in prothrombin time

Rare cases of changes in prothrombin time have been described in patients receiving ceftriaxone. Patients with vitamin K deficiency (impaired synthesis, malnutrition) may require monitoring of prothrombin time during therapy and administration of vitamin K (10 mg/week) if the prothrombin time increases before or during therapy.

Formation of precipitates of ceftriaxone calcium salt

Cases of fatal reactions resulting from the deposition of ceftriaxone-calcium precipitates in the lungs and kidneys of newborns have been described. Theoretically, there is a possibility of interaction of ceftriaxone with calcium-containing solutions for intravenous administration in other age groups of patients, therefore ceftriaxone should not be mixed with calcium-containing solutions (including for parenteral nutrition), and also administered simultaneously, including through separate access for infusions at different areas. Theoretically, based on the calculation of the 5 half-lives of ceftriaxone, the interval between the administration of ceftriaxone and calcium-containing solutions should be at least 48 hours.

There are no data on the possible interaction of ceftriaxone with calcium-containing drugs for oral administration, as well as ceftriaxone for intramuscular administration with potassium-containing drugs (intravenously or orally).

After using ceftriaxone, usually in doses exceeding the standard recommended (1.0 g per day or more), ultrasound examination of the gallbladder revealed precipitates of the calcium salt of ceftriaxone, the formation of which is most likely in pediatric patients. Precipitates rarely cause any symptoms and disappear after completion or cessation of ceftriaxone therapy. If these phenomena 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.

Although there is evidence of the formation of intravascular precipitates only in neonates when using ceftriaxone and calcium-containing infusion solutions or any other calcium-containing drugs, Ceftriaxone should not be mixed or prescribed to children and adult patients simultaneously with calcium-containing infusion solutions, even using different venous approaches (see sections “Contraindications”, “Interaction with other drugs”).

Pancreatitis

Rare cases of pancreatitis, possibly due to bile duct obstruction, have been described in patients receiving ceftriaxone. Most of these patients had preexisting risk factors for biliary congestion, such as prior therapy, severe illness, and total parenteral nutrition. At the same time, it is impossible to exclude the triggering role in the development of pancreatitis of precipitates formed under the influence of ceftriaxone in the biliary tract.

Use in children

The safety and effectiveness of ceftriaxone in neonates, infants, and young children have been determined at the dosages described in the Dosage and Administration section. Studies have shown that, like other cephalosporins, ceftriaxone can displace bilirubin from binding to serum albumin. Ceftriaxone should not be used in newborns, especially premature infants, who are at risk of developing bilirubin encephalopathy (see section "Contraindications").

Long-term treatment

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

Blood test monitoring

During long-term treatment, a complete blood count should be performed regularly.

Serological studies

When treated with ceftriaxone, false-positive results of the Coombs test, galactosemia test, and determination of glucose in urine may be observed (it is recommended to determine glucosuria only by the enzyme method).

Ceftriaxone analogues, what can replace the drug?

Level 4 ATC code matches:
Cephosin

Lendatsin

Medakson

Loprax

Cefixime

Lorakson

Sulperazon

Cefoperazone

Rocephin

Tsedex

Fortum

Ceftazidime

Cefotaxime

Cefix

Ceforal Solutab

Pantsef

Claforan

Cefodox

Suprax Solutab

Analogues of Ceftriaxone in injections:

• Ceftriaxone-LEKSVM (Kabi, Jodas, KMP, Promed, Vial, Elfa)
• Ceftriabol
• Tsefson
• Cefaxon
• Torotsef
• Hizon
• Cephogram
• Medakson
• Lorakson
• Ifitsef

Analogues in tablets:

• Pantsef
• Suprax Solutab
• Ceforal Solutab
• Cefpotec
• Spectraceph

Ceftriaxone or Cefazolin - which is better?

Both drugs belong to the cephalosporin group, but Ceftriaxone is a third-generation antibiotic, and Cefazolin is a first-generation drug.

An important feature of first generation cephalosporin antibiotics is that they are not effective against listeria and enterococci, have a narrow spectrum of action and a low level of activity against gram(-) bacteria.

Cefazolin is used mainly in surgery for perioperative prophylaxis, as well as for the treatment of soft tissue and skin infections.

Its prescription for the treatment of infections of the genitourinary system and respiratory tract cannot be considered as justified, which is associated with a narrow spectrum of antimicrobial activity and high resistance to it among potential pathogens.

Which is better: Ceftriaxone or Cefotaxime?

Cefotaxime and Ceftriaxone are the basic antimicrobial agents of the third generation cephalosporin group. The drugs are almost identical in their bactericidal properties.

Ceftriaxone during pregnancy and breastfeeding

The drug is contraindicated in the first trimester of pregnancy. If it is necessary to prescribe to a nursing woman, the child should be switched to formula.

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.

Considering that the drug (like other antibiotics) has side effects, it is prescribed only in cases where potential complications of the disease could be more harmful than the use of the drug (in particular, for infections of the urogenital tract, to which pregnant women are very susceptible).

How to dissolve Ceftriaxone with Procaine

Before taking Procaine as a solvent, you need to find out whether there are any contraindications to the use of Novocaine.
If the patient has increased susceptibility to Novocaine, then its use can provoke anaphylactic shock. Therefore, 0.5 ml of liquid product is injected into the muscle. If after half an hour there are no changes, then you can inject the rest of the dose, only into the other buttock.

Solutions must be prepared immediately before use.

Because of:

• the antibiotic in a dissolved state remains stable for only six hours;
• stale solution can increase pain symptoms. Freshly prepared liquid is used once.

How to dilute Ceftriaxone with Novocaine, what is needed for this?

1. To prepare a solution with Novocaine, you need to add 5 ml of Novocaine to a syringe for 1 g of Ceftriaxone. With a smaller quantity, the powder content of the bottle will not completely dissolve. The syringe, or rather the needle, will become clogged with undissolved lumps.
2. Then the syringe with the solvent is injected into the bottle with the powder. Shake the contents well without removing the corner. The diluted drug is ready for use.
3. After dilution, as much liquid medicine as required is drawn into the syringe. The rest is thrown away.

The instructions for use indicate Lidocaine as the agent that is recommended for diluting the powdered drug. But the use of special water for injection is allowed, as well as Procaine.

Reviews of Ceftriaxone

Ceftriaxone is a potent antibiotic (reviews from doctors confirm this fact), which helps cure the disease in a short time and with a minimum number of side effects. It is allowed to be used for children and during pregnancy (exception - 1st trimester).

According to the patients themselves, the main disadvantage of the drug is that the injections are very painful.

In reviews of Ceftriaxone injections for children, to facilitate the procedure, mothers (on the advice of the attending physician) are recommended to use Emla , which is a local anesthetic. It is applied in about half an hour to the intended injection site.

Is the lidocaine solution better?

It is believed that it is better to dilute the powder preparation with Lidocaine.

Procaine may:

1. Provoke the appearance of anaphylactic shock.
2. Reduces the bactericidal effects of the drug.

The instructions for use recommend using a 1% analgesic composition. You just need to say that the pharmacy does not always have a 1% solution, more often there is 2%.

Therefore, doctors recommend:

1. Dilute 2% analgesic with distilled water to obtain 1%. To do this, draw 1 ml of Lidocaine into the syringe, and then 1 ml of water.
2. Introduce the resulting liquid into a bottle with powder. Shake the mixture well. The liquid should sit for a minute or two. Then it is ready for use.
3. The resulting liquid is used for intramuscular injections. Usually the injection is given in the upper quadrant of the gluteal muscle. The procedure must be carried out leisurely, slowly, so as not to provoke additional pain.

Why is it better to dilute Ceftriaxone with Lidocaine? Patients note that such mixtures are less painful. Not freshly prepared medicine can increase pain.

However! Lidocaine antibiotic is used for intramuscular administration only. For intravenous administration, use a solution of Ceftriaxone with Novocaine or distilled water.

For adults, the instructions for use recommend injections 2 times a day. An adult patient receives 0.5 g at a time. If the disease is severe, the dose can be increased to 2 - 4 grams per day.

Ceftriaxone price, where to buy

How much does an antibiotic cost in Russian pharmacies? The price of Ceftriaxone injections varies depending on which company produces it, as well as the number of ampoules in each package and the concentration of the active substance in the vial.

The price of Ceftriaxone in Russian pharmacies is from 30 rubles per bottle.

The price of Ceftriaxone in Ukraine is from 15 UAH. per bottle of 1 g. At the same time, there is no significant difference between prices in the capital's pharmacies and pharmacies in other cities (Kharkov, Dnepropetrovsk, Lvov).

It is impossible to buy Ceftriaxone tablets. The drug is intended exclusively for parenteral administration.

• Online pharmacies in RussiaRussia
• Online pharmacies in UkraineUkraine
• Online pharmacies in KazakhstanKazakhstan

ZdravCity

• Ceftriaxone por.
  for preg sol. for i.v. and i.m. input. fl. 1000 mg RUP Belmedpreparaty 53 rub. order
• Ceftriaxone powder for injection solution for IV and IM injection. 1g bottle of Rapharma JSC

  45 rub. order

• Ceftriaxone powder prig solution for intravenous and intramuscular injection. fl. 1gPAO Biosintez

  43 RUR order

• Ceftriaxone por. ready solutions for intravenous and intramuscular injection. 1g 10pcs Borisov Medical Preparations Plant OJSC

  RUR 797 order

• Ceftriaxone powder for injection solution 1g bottle JSC Pharmaceutical company LEKKO

  41 rub. order

Pharmacy Dialogue

• Ceftriaxone (vial 1g IM, IV) Belmedpreparaty

  43 RUR order

• Ceftriaxone (vial 1g intravenous i.m. individual pack) Rapharma CJSC

  49 RUR order

• Ceftriaxone (vial 1g intravenous i.m. individual pack) Lecco JSC

  46 RUR order

• Ceftriaxone 1g IV IM ind. upbzmp

  43 RUR order

• Ceftriaxone (vial 1g IM, IV) Lecco JSC

  46 RUR order

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Pharmacy24

• Ceftriaxone 1 g N10 powder PAT "Kievmedpreparat", Ukraine
  151 UAH.order
• Ceftriaxone-BHFZ 500 mg No. 1 powder PAT NVC "Borshchagivsky chemical-pharmaceutical plant", Kiev, Ukraine

  11 UAH order

• Ceftriaxone-Darnitsa 0.5 g N5 lyophilisate for the preparation of solution for injection PrAT" Pharmaceutical company "Darnitsa", Ukraine

  58 UAH order

• Ceftriaxone-Darnitsa 1 g No. 5 solution PrAT” Pharmaceutical company “Darnitsa”, Ukraine

  72 UAH order

• Ceftriaxone 1.0 g No. 1 powder AT Lekhim-Kharkiv, Ukraine

  13 UAH order

PaniPharmacy

• Ceftriaxone bottle Ceftriaxone sodium salt powder for injection 1g Ukraine, Kievmedpreparat OJSC

  169 UAH order

• CEFTRIAXONE bottle Ceftriaxone powder for injection 1g No. 5 Ukraine, Lekhim-Kharkov JSC

  74 UAH order

• Ceftriaxone bottle Ceftriaxone sodium salt powder for injection 0.5g Ukraine, Kievmedpreparat OJSC

  110 UAH order

• Ceftriaxone bottle Ceftriaxone powder for injection 1g bottles No. 40 Ukraine, Darnitsa ChAO

  681 UAH order

• CEFTRIAXONE bottle Ceftriaxone powder for injection 1g Ukraine, Lekhim-Kharkov JSC

  15 UAH order

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Procedure for preparing the solution

1. Collect everything you need and place it on a pre-prepared and thoroughly disinfected wide plate or dish.
2. Wash your hands thoroughly. For this, laundry soap with the highest alkalinity is best suited. Wipe with a clean towel and disinfect with an antiseptic solution. If there are no sterile medical gloves, then special attention should be paid to hand cleanliness.
3. Using tweezers or other available means, remove the protective valve from the lid of the bottle with powder.

4. Both the rubber cap and the ampoule at the site of the break must be thoroughly disinfected.

5. Open the ampoule with the special file included with the package. If such a tool is not included, you simply need to break off the upper part of the ampoule by attaching a piece of cotton wool or a sterile swab to it.

6. Replace the needle on the syringe with the one with which the solution will be mixed. As a rule, for this purpose a needle of a larger diameter is used than the one with which the injection is supposed to be given. Now we draw the solvent from the ampoule into the syringe.

7. We pierce the rubber cap of the medicine bottle and, pressing on the piston, introduce all the solvent there.

   
   Then, without removing the needle and syringe, you need to carefully shake the bottle until the powder dissolves. You can find out what the finished solution should look like in the instructions for the drug.

   Attention

   To avoid compromising sterility, never touch the needle with your hands during manipulations to prepare the solution.

8. The solution is ready. Now we remove the syringe from the bottle and change the needle to the one that we will use for the injection. Already with this needle, we draw the solution from the bottle, turning it upside down so that the tip of the needle is immersed in the liquid.

9. After you have filled the entire solution into the syringe, carefully remove the needle from the bottle. Turn the syringe over with the piston down and lightly tap your fingers to shake the solution so that all the air bubbles collect at the top. Then, by pressing the plunger, remove air from the syringe. Droplets of solution that appear usually indicate that there is no more air in the syringe.
10. We put a cap on the needle (if you are not going to inject immediately). Solution in a syringe. Everything is ready for the procedure.

We recommend reading:

1. How to place an IV?
2. Blood clotting mechanism (INR). Measurement and norms
3. How to make an intradermal injection yourself?
4. Installation of an intravenous catheter and rules for caring for it
5. How to give yourself an intramuscular injection?
6. How to give a subcutaneous injection to yourself?
7. How to choose a needle and syringe for giving an injection

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