Ro·ceph·in (r -s f  n) A trademark for the drug ceftriaxone. |
Rocephin,
ceftriaxone sodium
Rocephin
Pharmacologic class: Third-generation cephalosporin
Therapeutic class: Anti-infective
Pregnancy risk category B
Action
Interferes with bacterial cell-wall synthesis and division by binding to cell wall, causing cell to die. Active against gram-negative and gram-positive bacteria, with expanded activity against gram-negative bacteria. Exhibits minimal immunosuppressant activity.
Availability
Powder for injection: 250 mg, 500 mg, 1 g, 2 g
Premixed containers: 1 g/50 ml, 2 g/50 ml
⊘Indications and dosages
➣ Infections of respiratory system, bones, joints, and skin; septicemia
Adults: 1 to 2 g/day I.M. or I.V. or in equally divided doses q 12 hours. Maximum daily dosage is 4 g.
➣ Uncomplicated gonorrhea
Adults: 250 mg I.M. as a single dose
➣ Surgical prophylaxis
Adults: 1 g I.V. as a single dose within 1 hour before start of surgical procedure
➣ Meningitis
Adults: 1 g to 2 g I.V. q 12 hours for 10 to 14 days
Children: Initially, 100 mg/kg/day I.M. or I.V. (not to exceed 4 g). Then 100 mg/kg/day I.M. or I.V. once daily or in equally divided doses q 12 hours (not to exceed 4 g) for 7 to 14 days.
➣ Otitis media
Children: 50 mg/kg I.M. as a single dose; maximum of 1 g/dose.
➣ Skin and skin-structure infections
Children: 50 to 75 mg/kg/day I.V. or I.M. once or twice daily. Maximum dosage is 2 g daily.
➣ Other serious infections
Children: 50 to 75 mg/kg/day I.V. or I.M. once or twice daily
Off-label uses
• Disseminated gonorrhea
• Endocarditis
• Epididymitis
• Gonorrhea-associated meningitis
• Lyme disease
• Neisseria meningitides carriers
• Pelvic inflammatory disease
Contraindications
• Hypersensitivity to cephalosporins or penicillins
Precautions
Use cautiously in:
• renal impairment, hepatic disease, biliary obstruction, phenylketonuria
• history of GI disease
• elderly patients
• pregnant or breastfeeding patients.
Administration
• Obtain specimens for culture and sensitivity testing as necessary before starting therapy.
• Know that drug for I.V. injection is compatible with sterile water, normal saline solution, dextrose 5% in water (D5W), half-normal saline solution, and D5W and normal saline solution.
• After reconstituting, dilute further to desired concentration for intermittent I.V. infusion. Infuse over 30 minutes.
• For I.M. use, reconstitute powder for injection with compatible solution by adding 0.9 ml of diluent to 250-mg vial, 1.8 ml to 500-mg vial, 3.6 ml to 1-g vial, or 7.2 ml to 2-g vial, to yield a concentration averaging 250 mg/ml.
• Divide high I.M. doses equally and administer in two separate sites. Inject deep into large muscle mass.
| Route | Onset | Peak | Duration |
| I.V. | Rapid | End of infusion | 12-24 hr |
| I.M. | Rapid | 1-2 hr | 12-24 hr |
Adverse reactions
CNS: headache, confusion, hemiparesis, lethargy, paresthesia, syncope, seizures
CV: hypotension, palpitations, chest pain, vasodilation
EENT: hearing loss
GI: nausea, vomiting, diarrhea, abdominal cramps, oral candidiasis, pseudomembranous colitis
GU: vaginal candidiasis
Hematologic: lymphocytosis, eosinophilia, bleeding tendency, hemolytic anemia, hypoprothrombinemia, neutropenia, thrombocytopenia, agranulocytosis, bone marrow depression
Hepatic: jaundice, hepatomegaly
Musculoskeletal: arthralgia
Respiratory: dyspnea
Skin: urticaria, maculopapular or erythematous rash
Other: chills, fever, superinfection, pain at I.M. injection site, anaphylaxis, serum sickness
Interactions
Drug-drug. Aminoglycosides, loop diuretics: increased risk of nephrotoxicity
Probenecid: decreased excretion and increased blood level of ceftriaxone
Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, eosinophils, gamma-glutamyltransferase, lactate dehydrogenase: increased levels
Coombs' test, urinary 17-ketosteroids, nonenzyme-based urine glucose tests (such as Clinitest): false-positive results
Hemoglobin, platelets, white blood cells: decreased values
Drug-herbs. Angelica, anise, arnica, asafetida, bogbean, boldo, celery, chamomile, clove, danshen, fenugreek, feverfew, garlic, ginger, ginkgo, ginseng, horse chestnut, horseradish, licorice, meadowsweet, onion, papain, passionflower, poplar, prickly ash, quassia, red clover, turmeric, wild carrot, wild lettuce, willow: increased risk of bleeding.
Patient monitoring
☞ Monitor for extreme confusion, tonic-clonic seizures, and mild hemiparesis when giving high doses.
• Monitor coagulation studies.
• Assess CBC and kidney and liver function test results.
• Monitor for signs and symptoms of superinfection and other serious adverse reactions.
• Be aware that cross-sensitivity to penicillins and cephalosporins may occur.
Patient teaching
• Instruct patient to report persistent diarrhea, bruising, or bleeding.
• Caution patient not to use herbs unless prescriber approves.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.
Rocephin®
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