Neonatal Drug Therapy Manual

CefTRIAXone sodium

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Updated March 5, 2024 - 2:36pm

Alternate Name(s): 
ROCEPHIN®
Classification: 
Antibiotic, Cephalosporin (Third Generation)
Original Date: 
July 2022
Indications: 
  • Prophylaxis for infants exposed to N gonorrhea (or at high risk of infection), both term and preterm, in the event of a shortage of erythromycin ophthalmic ointment 
  • For one dose only (see Side Effects and Notes section)
Administration: 
  • IM (preferred route)
  • IV intermittent infusion over 10-30 minutes
Dosage: 
  • One single dose of 50 mg/kg (maximum of 125 mg) IM/IV
Side Effects: 
  • Hypersensitivity reactions (ex: rash, pruritus, bronchospasm)
  • Immune Hemolytic Anemia
  • Local reactions at injection site:  pain, induration and tenderness, thrombophlebitis
  • GI: diarrhea;  biliary stasis from ceftriaxone is not considered to be a risk with a single dose, however, it is not recommended in patients who are hyperbilirubinemic (see Notes section)
Parameters to Monitor: 
  • Pain/reaction at injection site

  • CBC with differential, renal and hepatic function tests, PT are usually monitored with ceftriaxone usage, however, this is likely not necessary with one-dose regimes. 

Reconstitution and Stability: 

CHEO:

IV: ceftriaxone 100 mg/mL prepared by pharmacy

IM: Ceftriaxone 1 g vial:

  • Add 2.2 mL of 1% lidocaine without epinephrine (preservative free) 
  • Final Concentration: 350 mg/mL

 

TOH: 

IM: Ceftriaxone 1 g vial: 

  • Add 2.2 mL of 1% lidocaine without epinephrine (preservative free) 
  • Final Concentration: 350 mg/mL 
Compatibility: 

- Solutions Compatible:  dextrose up to D10W, 0.9% NS, dextrose-saline combinations

- Additives/Above Cassette Compatible: lidocaine 1% (without epinephrine) for IM injection

- Y-site Compatible:  Intralipid 20% , morphine, potassium chloride

Incompatible: calcium, fluconazole, vancomycin, aminoglycoside antibiotics: administration of beta lactam and aminoglycoside antibiotics should be separated.

No calcium or calcium-containing IV medications (ie. TPN and Lactated Ringers) should be given simultaneously  via a Y-site.  

Notes: 

Contraindications:

  • Ceftriaxone is contra-indicated in neonates (less than or equal to 28 days of age) if they require (or are expected to require) treatment with calcium containing IV solutions (including TPN, RL) because of the risk of precipitation of ceftriaxone with calcium. A single dose of cefotaxime [100 mg/kg given intravenously or intramuscularly] is an acceptable alternative.
  • Hyperbilirubinemic neonates and preterm neonates should not be treated with ceftriaxone. In vitro studies have shown that ceftriaxone can displace bilirubin from its binding to serum albumin, leading to a possible risk of bilirubin encephalopathy in these patients​
  • Sodium content is 3.6 mmol/g of ceftriaxone.
References: 
  • The Ottawa Hospital Parenteral Drug Therapy Manual
  • The Canadian Paediatric Society Position Statement on Preventing ophthalmia neonatorum, accessed July 2022. 
  • Lexi-Comp Online Database, accessed July 2022 
  • Sterimax Product Monograph. Date of Preparation: February 8, 2016. 

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