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ceftriaxone (injection)

Pronunciation

Generic Name: ceftriaxone (injection) (SEF trye AX one)
Brand Name: Rocephin, Rocephin IM Convenience Kit (obsolete), Rocephin ADD-Vantage

What is ceftriaxone?

Ceftriaxone is a cephalosporin (SEF a low spor in) antibiotic. It works by fighting bacteria in your body.

Ceftriaxone is used to treat many kinds of bacterial infections, including severe or life-threatening forms such as meningitis.

Ceftriaxone may also be used for purposes not listed in this medication guide.

What is the most important information I should know about ceftriaxone?

You should not use this medicine if you are allergic to ceftriaxone or to similar antibiotics, such as Ceftin, Cefzil, Keflex, Omnicef, and others. Tell your doctor if you are allergic to any drugs, especially penicillins or other antibiotics.

Do not use ceftriaxone in a child without a doctor's advice. Ceftriaxone should never be used in a premature baby, or in any newborn baby who has jaundice (yellowing of the skin or eyes).

What should I discuss with my health care provider before using ceftriaxone?

Do not use ceftriaxone in a child without a doctor's advice, and never give more than the child's prescribed dose. Ceftriaxone injection can be dangerous when given to a newborn baby with any intravenous medicines that contain calcium, including total parental nutrition (TPN). Ceftriaxone should never be used in a premature baby, or in any newborn baby who has jaundice.

You should not use this medicine if you are allergic to ceftriaxone or to other cephalosporin antibiotics, such as:

  • cefaclor (Raniclor);

  • cefadroxil (Duricef);

  • cefazolin (Ancef);

  • cefdinir (Omnicef);

  • cefditoren (Spectracef);

  • cefpodoxime (Vantin);

  • cefprozil (Cefzil);

  • ceftibuten (Cedax);

  • cefuroxime (Ceftin);

  • cephalexin (Keflex); or

  • cephradine (Velosef).

To make sure ceftriaxone is safe for you, tell your doctor if you have:

  • an allergy to any drugs (especially penicillins);

  • kidney disease (or if you are on dialysis);

  • liver disease;

  • diabetes;

  • gallbladder disease;

  • a stomach or intestinal disorder such as colitis;

  • poor nutrition; or

  • a condition for which you take a blood thinner (warfarin, Coumadin, Jantoven).

Ceftriaxone is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

Ceftriaxone can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

How should I use ceftriaxone?

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Ceftriaxone is injected into a muscle, or into a vein through an IV. You may be shown how to use an IV at home. Do not give yourself this medicine if you do not understand how to use the injection and properly dispose of needles, IV tubing, and other items used.

You may need to mix ceftriaxone with a liquid (diluent) before using it. If you are using the injections at home, be sure you understand how to properly mix and store the medication. Use only the diluent your doctor has recommended.

Do not mix ceftriaxone in the same injection with other antibiotics, or with any diluent that contains calcium, including a TPN (total parenteral nutrition) solution.

After mixing your medicine, you will need to use it within a certain number of hours or days. This will depend on the diluent and how you store the mixture (at room temperature, in a refrigerator, or frozen). Carefully follow the mixing and storage instructions provided with your medicine. Ask your pharmacist if you have questions.

If you use other injectable medications, be sure to flush your intravenous catheter between injections of each medication.

Use this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Ceftriaxone will not treat a viral infection such as the common cold or flu.

Ceftriaxone can cause unusual results with certain lab tests for glucose (sugar) in the urine. Tell any doctor who treats you that you are using this medicine.

Store unmixed ceftriaxone powder at room temperature, away from moisture, heat, and light.

If your medicine was provided in a frozen form or was frozen after mixing, thaw it in a refrigerator or at room temperature. Do not warm in a microwave or boiling water. Use the medicine as soon as possible after thawing it. Do not refreeze.

Use a disposable needle and syringe only once. Follow any state or local laws about throwing away used needles and syringes. Use a puncture-proof "sharps" disposal container (ask your pharmacist where to get one and how to throw it away). Keep this container out of the reach of children and pets.

What happens if I miss a dose?

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while using ceftriaxone?

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.

Ceftriaxone side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • a seizure (convulsions);

  • severe stomach pain, diarrhea that is watery or bloody;

  • sudden weakness or ill feeling, fever, chills, cold or flu symptoms, mouth sores;

  • pale or yellowed skin, dark colored urine;

  • severe pain in your upper stomach that comes and goes or spreads to your back;

  • a blood cell disorder--skin rash or tight feeling, severe tingling or numbness, pain, muscle weakness;

  • kidney or bladder problems--pain in your side or lower back spreading to your groin, blood in your urine, painful or difficult urination, little or no urine; or

  • severe skin reaction--fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Common side effects may include:

  • mild diarrhea;

  • warmth, tight feeling, or a hard lump where the injection was given;

  • vaginal itching or discharge;

  • rash; or

  • abnormal liver function tests.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Ceftriaxone dosing information

Usual Adult Dose for Bacteremia:

1 to 2 g IV or IM once a day (or in equally divided doses twice a day)

Duration of therapy: 4 to 14 days
-Complicated infections: Longer therapy may be required.
-Infections due to Streptococcus pyogenes: At least 10 days

Comments:
-Dose and duration depend on the nature and severity of the infection.
-The total daily dose should not exceed 4 g.

Uses: For the treatment of the following infections when due to susceptible organisms:
-Bacterial septicemia due to Staphylococcus aureus, S pneumoniae, Escherichia coli, Haemophilus influenzae, or Klebsiella pneumoniae
-Bone and joint infections due to S aureus, S pneumoniae, E coli, Proteus mirabilis, K pneumoniae, or Enterobacter species
-Lower respiratory tract infections due to S pneumoniae, S aureus, H influenzae, H parainfluenzae, K pneumoniae, E coli, Enterobacter aerogenes, P mirabilis, or Serratia marcescens
-Urinary tract infections (complicated and uncomplicated) due to E coli, P mirabilis, P vulgaris, Morganella morganii, or K pneumoniae

Usual Adult Dose for Joint Infection:

1 to 2 g IV or IM once a day (or in equally divided doses twice a day)

Duration of therapy: 4 to 14 days
-Complicated infections: Longer therapy may be required.
-Infections due to Streptococcus pyogenes: At least 10 days

Comments:
-Dose and duration depend on the nature and severity of the infection.
-The total daily dose should not exceed 4 g.

Uses: For the treatment of the following infections when due to susceptible organisms:
-Bacterial septicemia due to Staphylococcus aureus, S pneumoniae, Escherichia coli, Haemophilus influenzae, or Klebsiella pneumoniae
-Bone and joint infections due to S aureus, S pneumoniae, E coli, Proteus mirabilis, K pneumoniae, or Enterobacter species
-Lower respiratory tract infections due to S pneumoniae, S aureus, H influenzae, H parainfluenzae, K pneumoniae, E coli, Enterobacter aerogenes, P mirabilis, or Serratia marcescens
-Urinary tract infections (complicated and uncomplicated) due to E coli, P mirabilis, P vulgaris, Morganella morganii, or K pneumoniae

Usual Adult Dose for Osteomyelitis:

1 to 2 g IV or IM once a day (or in equally divided doses twice a day)

Duration of therapy: 4 to 14 days
-Complicated infections: Longer therapy may be required.
-Infections due to Streptococcus pyogenes: At least 10 days

Comments:
-Dose and duration depend on the nature and severity of the infection.
-The total daily dose should not exceed 4 g.

Uses: For the treatment of the following infections when due to susceptible organisms:
-Bacterial septicemia due to Staphylococcus aureus, S pneumoniae, Escherichia coli, Haemophilus influenzae, or Klebsiella pneumoniae
-Bone and joint infections due to S aureus, S pneumoniae, E coli, Proteus mirabilis, K pneumoniae, or Enterobacter species
-Lower respiratory tract infections due to S pneumoniae, S aureus, H influenzae, H parainfluenzae, K pneumoniae, E coli, Enterobacter aerogenes, P mirabilis, or Serratia marcescens
-Urinary tract infections (complicated and uncomplicated) due to E coli, P mirabilis, P vulgaris, Morganella morganii, or K pneumoniae

Usual Adult Dose for Pneumonia:

1 to 2 g IV or IM once a day (or in equally divided doses twice a day)

Duration of therapy: 4 to 14 days
-Complicated infections: Longer therapy may be required.
-Infections due to Streptococcus pyogenes: At least 10 days

Comments:
-Dose and duration depend on the nature and severity of the infection.
-The total daily dose should not exceed 4 g.

Uses: For the treatment of the following infections when due to susceptible organisms:
-Bacterial septicemia due to Staphylococcus aureus, S pneumoniae, Escherichia coli, Haemophilus influenzae, or Klebsiella pneumoniae
-Bone and joint infections due to S aureus, S pneumoniae, E coli, Proteus mirabilis, K pneumoniae, or Enterobacter species
-Lower respiratory tract infections due to S pneumoniae, S aureus, H influenzae, H parainfluenzae, K pneumoniae, E coli, Enterobacter aerogenes, P mirabilis, or Serratia marcescens
-Urinary tract infections (complicated and uncomplicated) due to E coli, P mirabilis, P vulgaris, Morganella morganii, or K pneumoniae

Usual Adult Dose for Septicemia:

1 to 2 g IV or IM once a day (or in equally divided doses twice a day)

Duration of therapy: 4 to 14 days
-Complicated infections: Longer therapy may be required.
-Infections due to Streptococcus pyogenes: At least 10 days

Comments:
-Dose and duration depend on the nature and severity of the infection.
-The total daily dose should not exceed 4 g.

Uses: For the treatment of the following infections when due to susceptible organisms:
-Bacterial septicemia due to Staphylococcus aureus, S pneumoniae, Escherichia coli, Haemophilus influenzae, or Klebsiella pneumoniae
-Bone and joint infections due to S aureus, S pneumoniae, E coli, Proteus mirabilis, K pneumoniae, or Enterobacter species
-Lower respiratory tract infections due to S pneumoniae, S aureus, H influenzae, H parainfluenzae, K pneumoniae, E coli, Enterobacter aerogenes, P mirabilis, or Serratia marcescens
-Urinary tract infections (complicated and uncomplicated) due to E coli, P mirabilis, P vulgaris, Morganella morganii, or K pneumoniae

Usual Adult Dose for Bacterial Infection:

1 to 2 g IV or IM once a day (or in equally divided doses twice a day)

Duration of therapy: 4 to 14 days
-Complicated infections: Longer therapy may be required.
-Infections due to Streptococcus pyogenes: At least 10 days

Comments:
-Dose and duration depend on the nature and severity of the infection.
-The total daily dose should not exceed 4 g.

Uses: For the treatment of the following infections when due to susceptible organisms:
-Bacterial septicemia due to Staphylococcus aureus, S pneumoniae, Escherichia coli, Haemophilus influenzae, or Klebsiella pneumoniae
-Bone and joint infections due to S aureus, S pneumoniae, E coli, Proteus mirabilis, K pneumoniae, or Enterobacter species
-Lower respiratory tract infections due to S pneumoniae, S aureus, H influenzae, H parainfluenzae, K pneumoniae, E coli, Enterobacter aerogenes, P mirabilis, or Serratia marcescens
-Urinary tract infections (complicated and uncomplicated) due to E coli, P mirabilis, P vulgaris, Morganella morganii, or K pneumoniae

Usual Adult Dose for Urinary Tract Infection:

1 to 2 g IV or IM once a day (or in equally divided doses twice a day)

Duration of therapy: 4 to 14 days
-Complicated infections: Longer therapy may be required.
-Infections due to Streptococcus pyogenes: At least 10 days

Comments:
-Dose and duration depend on the nature and severity of the infection.
-The total daily dose should not exceed 4 g.

Uses: For the treatment of the following infections when due to susceptible organisms:
-Bacterial septicemia due to Staphylococcus aureus, S pneumoniae, Escherichia coli, Haemophilus influenzae, or Klebsiella pneumoniae
-Bone and joint infections due to S aureus, S pneumoniae, E coli, Proteus mirabilis, K pneumoniae, or Enterobacter species
-Lower respiratory tract infections due to S pneumoniae, S aureus, H influenzae, H parainfluenzae, K pneumoniae, E coli, Enterobacter aerogenes, P mirabilis, or Serratia marcescens
-Urinary tract infections (complicated and uncomplicated) due to E coli, P mirabilis, P vulgaris, Morganella morganii, or K pneumoniae

Usual Adult Dose for Bronchitis:

1 to 2 g IV or IM once a day (or in equally divided doses twice a day)

Duration of therapy: 4 to 14 days
-Complicated infections: Longer therapy may be required.
-Infections due to Streptococcus pyogenes: At least 10 days

Comments:
-Dose and duration depend on the nature and severity of the infection.
-The total daily dose should not exceed 4 g.

Uses: For the treatment of the following infections when due to susceptible organisms:
-Bacterial septicemia due to Staphylococcus aureus, S pneumoniae, Escherichia coli, Haemophilus influenzae, or Klebsiella pneumoniae
-Bone and joint infections due to S aureus, S pneumoniae, E coli, Proteus mirabilis, K pneumoniae, or Enterobacter species
-Lower respiratory tract infections due to S pneumoniae, S aureus, H influenzae, H parainfluenzae, K pneumoniae, E coli, Enterobacter aerogenes, P mirabilis, or Serratia marcescens
-Urinary tract infections (complicated and uncomplicated) due to E coli, P mirabilis, P vulgaris, Morganella morganii, or K pneumoniae

Usual Adult Dose for Gonococcal Infection -- Uncomplicated:

250 mg IM as a single dose

Uses: For the treatment of uncomplicated cervical/urethral and rectal gonorrhea due to Neisseria gonorrhoeae (including penicillinase- and nonpenicillinase-producing strains) and pharyngeal gonorrhea due to nonpenicillinase-producing strains of N gonorrhoeae

US CDC Recommendations: 250 mg IM as a single dose

Comments:
-With azithromycin, the recommended regimen for uncomplicated infections of the pharynx, cervix, urethra, and rectum
-Preferable to administer this drug and azithromycin simultaneously and under direct observation
-Suspected treatment failures should first be retreated with the recommended regimen as reinfections more likely than treatment failures.
-The patient's sexual partner(s) should also be evaluated/treated.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Intraabdominal Infection:

1 to 2 g IV or IM once a day (or in equally divided doses twice a day)

Duration of therapy: 4 to 14 days
-Complicated infections: Longer therapy may be required.

Comments:
-Dose and duration depend on the nature and severity of the infection.
-The total daily dose should not exceed 4 g.
-Most strains of Clostridium difficile have been reported as resistant.

Uses: For the treatment of intraabdominal infections due to E coli, K pneumoniae, Bacteroides fragilis, Clostridium species, or Peptostreptococcus species

Infectious Diseases Society of America (IDSA) and Surgical Infection Society (SIS) Recommendations: 1 to 2 g IV every 12 to 24 hours

Comments:
-With metronidazole, recommended for complicated community-acquired infection (perforated or abscessed appendicitis and other infections of mild to moderate severity)
-Recommended for community-acquired acute cholecystitis of mild to moderate severity
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Meningitis:

1 to 2 g IV or IM once a day (or in equally divided doses twice a day)

Duration of therapy: 4 to 14 days
-Complicated infections: Longer therapy may be required.

Comments:
-Dose and duration depend on the nature and severity of the infection.
-The total daily dose should not exceed 4 g.
-This drug has been effective in a limited number of cases of meningitis and shunt infection due to S epidermidis and E coli.

Use: For the treatment of meningitis due to H influenzae, N meningitidis, or S pneumoniae

IDSA Recommendations:
-Bacterial meningitis: 4 g IV every 24 hours (or in equally divided doses every 12 hours) for 7 to at least 21 days

US CDC Recommendations:
-Gonococcal meningitis: 1 to 2 g IV every 12 to 24 hours for 10 to 14 days

Comments:
-Duration of bacterial meningitis therapy should be based on isolated pathogen.
-With azithromycin, the recommended regimen for gonococcal meningitis; the patient's sexual partner(s) should also be evaluated/treated.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Pelvic Inflammatory Disease:

1 to 2 g IV or IM once a day (or in equally divided doses twice a day)

Duration of therapy: 4 to 14 days
-Complicated infections: Longer therapy may be required.

Comments:
-Dose and duration depend on the nature and severity of the infection.
-The total daily dose should not exceed 4 g.
-This drug has no activity against Chlamydia trachomatis; appropriate antichlamydial therapy should be added when C trachomatis is a suspected pathogen.

Use: For the treatment of pelvic inflammatory disease (PID) due to N gonorrhoeae

US CDC Recommendations: 250 mg IM as a single dose

Comments:
-Part of a recommended IM/oral regimen for acute PID (of mild to moderate severity); this drug should be used with doxycycline (with or without metronidazole).
-Patients not responding to IM/oral therapy within 72 hours should be reevaluated to confirm diagnosis and should receive IV therapy.
-The patient's sexual partner(s) should also be evaluated/treated.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Skin or Soft Tissue Infection:

1 to 2 g IV or IM once a day (or in equally divided doses twice a day)

Duration of therapy: 4 to 14 days
-Complicated infections: Longer therapy may be required.
-Infections due to S pyogenes: At least 10 days

Comments:
-Dose and duration depend on the nature and severity of the infection.
-The total daily dose should not exceed 4 g.

Uses: For the treatment of skin and skin structure infections due to S aureus, S epidermidis, S pyogenes, viridans group streptococci, E coli, E cloacae, K oxytoca, K pneumoniae, P mirabilis, M morganii, Pseudomonas aeruginosa, S marcescens, Acinetobacter calcoaceticus, B fragilis, or Peptostreptococcus species

IDSA Recommendations:
-Incisional surgical site infection: 1 g IV every 24 hours
-Aeromonas hydrophila necrotizing infection: 1 to 2 g IV every 24 hours
-Vibrio vulnificus necrotizing infection: 1 g IV once a day
-Infection after animal bite: 1 g IV every 12 hours

Comments:
-Recommended for use with metronidazole as a combination regimen for treatment of incisional surgical site infections after intestinal or genitourinary tract surgery.
-Recommended for use with metronidazole for treatment of incisional surgical site infections after surgery of axilla or perineum; coverage for methicillin-resistant S aureus may be needed.
-In combination with doxycycline, recommended as a preferred IV drug for the treatment of necrotizing infections of the skin, fascia, and muscle due to A hydrophila or V vulnificus
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Skin and Structure Infection:

1 to 2 g IV or IM once a day (or in equally divided doses twice a day)

Duration of therapy: 4 to 14 days
-Complicated infections: Longer therapy may be required.
-Infections due to S pyogenes: At least 10 days

Comments:
-Dose and duration depend on the nature and severity of the infection.
-The total daily dose should not exceed 4 g.

Uses: For the treatment of skin and skin structure infections due to S aureus, S epidermidis, S pyogenes, viridans group streptococci, E coli, E cloacae, K oxytoca, K pneumoniae, P mirabilis, M morganii, Pseudomonas aeruginosa, S marcescens, Acinetobacter calcoaceticus, B fragilis, or Peptostreptococcus species

IDSA Recommendations:
-Incisional surgical site infection: 1 g IV every 24 hours
-Aeromonas hydrophila necrotizing infection: 1 to 2 g IV every 24 hours
-Vibrio vulnificus necrotizing infection: 1 g IV once a day
-Infection after animal bite: 1 g IV every 12 hours

Comments:
-Recommended for use with metronidazole as a combination regimen for treatment of incisional surgical site infections after intestinal or genitourinary tract surgery.
-Recommended for use with metronidazole for treatment of incisional surgical site infections after surgery of axilla or perineum; coverage for methicillin-resistant S aureus may be needed.
-In combination with doxycycline, recommended as a preferred IV drug for the treatment of necrotizing infections of the skin, fascia, and muscle due to A hydrophila or V vulnificus
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Surgical Prophylaxis:

1 g IV as a single dose 30 to 120 minutes before surgery

Comments:
-Preoperative use of this drug may reduce the incidence of postoperative infections in patients undergoing surgical procedures classified as contaminated or potentially contaminated (e.g., vaginal or abdominal hysterectomy, cholecystectomy for chronic calculous cholecystitis in high-risk patients [such as those older than 70 years] with acute cholecystitis not requiring therapeutic antimicrobials, obstructive jaundice, common duct bile stones) and in surgical patients for whom infection at the operative site would present serious risk (e.g., during coronary artery bypass surgery).
-This drug shown to be as effective as cefazolin to prevent infection after coronary artery bypass surgery; no placebo-controlled trials to evaluate any cephalosporin preventing infection after coronary artery bypass surgery.

American Society of Health-System Pharmacists (ASHP), IDSA, SIS, and Society for Healthcare Epidemiology of America (SHEA) Recommendations:
-Preoperative dose: 2 g IV as a single dose, starting within 60 minutes before surgical incision

Comments:
-A single prophylactic dose is usually sufficient; if prophylaxis is continued postoperatively, duration should be less than 24 hours.
-Readministration may be needed for unusually long procedures to ensure adequate serum and tissue drug levels.
-Redosing may be needed if drug half-life is shortened (e.g., extensive burns) or if prolonged/excessive bleeding during surgery; redosing may not be needed if drug half-life is prolonged (e.g., renal dysfunction).
-Current guidelines should be consulted for additional information.

Uses: For surgical prophylaxis for the following procedures:
-Biliary tract (recommended regimen): Open procedure and elective, high-risk laparoscopic procedure; should limit to patients requiring antimicrobial therapy for acute cholecystitis or acute biliary tract infections (which may not be established before incision), not patients undergoing cholecystectomy for noninfected biliary conditions (including biliary colic or dyskinesia without infection)
-Colorectal (with metronidazole, as a recommended regimen)

Usual Adult Dose for Chancroid:

US CDC Recommendations: 250 mg IM as a single dose

Comments:
-The causative organism is H ducreyi.
-Patients should be reexamined 3 to 7 days after therapy.
-Uncircumcised men and HIV-infected patients do not respond as well to therapy as circumcised men and HIV-negative patients; HIV testing recommended at chancroid diagnosis.
-HIV-infected patients may require repeated or longer treatment regimens; these patients should be monitored closely.
-Patients should be retested for syphilis and HIV 3 months after chancroid diagnosis, if initial tests were negative.
-The patient's sexual partner(s) should also be evaluated/treated.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Conjunctivitis:

US CDC Recommendations: 1 g IM as a single dose

Comments:
-With azithromycin, the recommended regimen for gonococcal conjunctivitis
-Consultation with an infectious disease specialist and a one-time lavage of the infected eye with saline solution should be considered.
-The patient's sexual partner(s) should also be evaluated/treated.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Endocarditis:

American Heart Association (AHA) and IDSA Recommendations (for patients with normal renal function):
Infection due to viridans group streptococci, S bovis, or HACEK microorganisms or culture-negative infection (including Bartonella endocarditis): 2 g IV or IM every 24 hours

Duration of therapy:
-Native valve infection due to viridans group streptococci, S bovis, or HACEK microorganisms: 4 weeks
-Prosthetic valve (or other prosthetic material) infection due to viridans group streptococci, S bovis, or HACEK microorganisms: 6 weeks
-Suspected Bartonella endocarditis (culture negative): 6 weeks

Native or prosthetic valve infection due to Enterococcus faecalis strains resistant to penicillin, aminoglycosides, and vancomycin: 2 g IV or IM every 12 hours for at least 8 weeks

US CDC Recommendations:
Gonococcal endocarditis: 1 to 2 g IV every 12 to 24 hours for at least 4 weeks

Comments:
-Native valve infection due to highly penicillin-susceptible viridans group streptococci or S bovis: If this drug is used with gentamicin, the duration of therapy may be reduced to 2 weeks; 2-week regimen not recommended if known cardiac/extracardiac abscess, CrCl less than 20 mL/min, impaired 8th cranial nerve function, or Abiotrophia, Granulicatella, or Gemella species infection.
-Native valve infection due to viridans group streptococci or S bovis relatively resistant to penicillin: This drug should be used with gentamicin.
-Prosthetic valve (or other prosthetic material) infection due to viridans group streptococci or S bovis: This drug may be used with or without gentamicin if penicillin-susceptible strain (MIC up to 0.12 mcg/mL) but should be used with gentamicin if relatively/fully penicillin-resistant strain (MIC greater than 0.12 mcg/mL).
-HACEK microorganisms include H parainfluenzae, Aggregatibacter aphrophilus, A actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae.
-Suspected Bartonella endocarditis (culture negative): This drug should be used with gentamicin (with or without doxycycline); infectious diseases specialist should be consulted.
-Native/prosthetic valve infection due to E faecalis strains resistant to penicillin, aminoglycosides, and vancomycin: This drug should be used with ampicillin.
-Gonococcal endocarditis: This drug should be used azithromycin (the recommended regimen); the patient's sexual partner(s) should also be evaluated/treated.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Bacterial Endocarditis Prophylaxis:

AHA and IDSA Recommendations: 1 g IV or IM as a single dose 30 to 60 minutes before dental procedure

Comments:
-Recommended as an alternative in patients, with or without penicillin/ampicillin allergy, unable to take oral medication (unless history of anaphylaxis, angioedema, or urticaria with penicillins or ampicillin)
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Epididymitis -- Sexually Transmitted:

US CDC Recommendations: 250 mg IM as a single dose

Comments:
-With doxycycline, the recommended regimen for acute epididymitis most likely due to sexually-transmitted chlamydia and gonorrhea
-With levofloxacin or ofloxacin, the recommended regimen for acute epididymitis most likely due to sexually-transmitted chlamydia and gonorrhea and enteric organisms (men practicing insertive anal sex)
-All patients should be tested for other sexually-transmitted infections (including HIV).
-The patient's sexual partner(s) should also be evaluated/treated.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Gonococcal Infection -- Disseminated:

US CDC Recommendations:
-Arthritis and arthritis-dermatitis syndrome: 1 g IV or IM every 24 hours
-Gonococcal endocarditis and meningitis: 1 to 2 g IV every 12 to 24 hours

Duration of therapy:
-Arthritis-dermatitis syndrome: At least 7 days (total)
-Gonococcal endocarditis: At least 4 weeks
-Gonococcal meningitis: 10 to 14 days

Comments:
-With azithromycin, the recommended regimen for disseminated gonococcal infection (DGI)
-Hospitalization and consultation with an infectious disease specialist recommended for initial therapy, particularly for patients who may be noncompliant with therapy, have an uncertain diagnosis, or have purulent synovial effusions/other complications; patients should be examined for clinical signs of endocarditis and meningitis.
-Arthritis-dermatitis syndrome: Can switch to oral therapy (guided by antimicrobial susceptibility testing) 24 to 48 hours after significant clinical improvement
-The patient's sexual partner(s) should also be evaluated/treated.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Lyme Disease -- Arthritis:

American Academy of Neurology (AAN) and IDSA Recommendations: 2 g IV once a day
Duration of therapy: 14 days

Comments:
-IDSA recommends this drug as the preferred parenteral regimen for early neurologic disease (meningitis or radiculopathy), cardiac disease, and late disease (recurrent arthritis after oral regimen, central or peripheral nervous system disease).
-Duration of therapy has ranged from 10 to 28 days.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Lyme Disease -- Carditis:

American Academy of Neurology (AAN) and IDSA Recommendations: 2 g IV once a day
Duration of therapy: 14 days

Comments:
-IDSA recommends this drug as the preferred parenteral regimen for early neurologic disease (meningitis or radiculopathy), cardiac disease, and late disease (recurrent arthritis after oral regimen, central or peripheral nervous system disease).
-Duration of therapy has ranged from 10 to 28 days.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Lyme Disease -- Neurologic:

American Academy of Neurology (AAN) and IDSA Recommendations: 2 g IV once a day
Duration of therapy: 14 days

Comments:
-IDSA recommends this drug as the preferred parenteral regimen for early neurologic disease (meningitis or radiculopathy), cardiac disease, and late disease (recurrent arthritis after oral regimen, central or peripheral nervous system disease).
-Duration of therapy has ranged from 10 to 28 days.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Meningococcal Meningitis Prophylaxis:

US CDC Recommendations: 250 mg IM as a single dose

Usual Adult Dose for Neurosyphilis:

US CDC, National Institutes of Health (NIH), and HIV Medicine Association of the IDSA (HIVMA/IDSA) Recommendations for HIV-infected Patients: 2 g IV or IM once a day for 10 to 14 days

Comments:
-Recommended for penicillin-allergic patients (when desensitization to penicillin is not possible) with neurosyphilis, otic, or ocular disease
-The patient's sexual partner(s) should also be evaluated/treated.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Proctitis:

US CDC Recommendations: 250 mg IM as a single dose

Comments:
-With doxycycline, the recommended regimen for acute proctitis
-All patients should be tested for HIV and syphilis.
-The patient's sexual partner(s) should also be evaluated/treated.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Salmonella Enteric Fever:

US CDC, NIH, and HIVMA/IDSA Recommendations for HIV-infected Patients: 1 g IV every 24 hours

Duration of Salmonellosis Therapy:
For gastroenteritis without bacteremia:
-If CD4 count at least 200 cells/mm3: 7 to 14 days
-If CD4 count less than 200 cells/mm3: 2 to 6 weeks

For gastroenteritis with bacteremia:
-If CD4 count at least 200 cells/mm3: 14 days; longer if persistent bacteremia or complicated infection (e.g., metastatic foci of infection present)
-If CD4 count less than 200 cells/mm3: 2 to 6 weeks

Comments:
-Recommended as alternative empiric therapy for bacterial enteric infections (pending diagnostic studies) and as alternative therapy for salmonella gastroenteritis with or without bacteremia
-Empiric therapy for bacterial enteric infections recommended for patients with advanced HIV (CD4 count less than 200 cells/mm3 or concomitant AIDS-defining illnesses) and clinically severe diarrhea (at least 6 stools/day or bloody stool) and/or associated fever/chills. Fecal samples should be obtained for diagnostic testing before starting therapy; therapy should be adjusted based on those results.
-All HIV-infected patients with salmonellosis should receive antibiotic therapy; increased risk of bacteremia (by 20- to 100-fold) and mortality (by up to 7-fold) compared to HIV-negative subjects.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Salmonella Gastroenteritis:

US CDC, NIH, and HIVMA/IDSA Recommendations for HIV-infected Patients: 1 g IV every 24 hours

Duration of Salmonellosis Therapy:
For gastroenteritis without bacteremia:
-If CD4 count at least 200 cells/mm3: 7 to 14 days
-If CD4 count less than 200 cells/mm3: 2 to 6 weeks

For gastroenteritis with bacteremia:
-If CD4 count at least 200 cells/mm3: 14 days; longer if persistent bacteremia or complicated infection (e.g., metastatic foci of infection present)
-If CD4 count less than 200 cells/mm3: 2 to 6 weeks

Comments:
-Recommended as alternative empiric therapy for bacterial enteric infections (pending diagnostic studies) and as alternative therapy for salmonella gastroenteritis with or without bacteremia
-Empiric therapy for bacterial enteric infections recommended for patients with advanced HIV (CD4 count less than 200 cells/mm3 or concomitant AIDS-defining illnesses) and clinically severe diarrhea (at least 6 stools/day or bloody stool) and/or associated fever/chills. Fecal samples should be obtained for diagnostic testing before starting therapy; therapy should be adjusted based on those results.
-All HIV-infected patients with salmonellosis should receive antibiotic therapy; increased risk of bacteremia (by 20- to 100-fold) and mortality (by up to 7-fold) compared to HIV-negative subjects.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for STD Prophylaxis:

US CDC Recommendations: 250 mg IM as a single dose

Comments:
-With azithromycin and (metronidazole or tinidazole), the recommended regimen for presumptive therapy after sexual assault
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Syphilis -- Early:

US CDC, NIH, and HIVMA/IDSA Recommendations for HIV-infected Patients: 1 g IV or IM once a day for 10 to 14 days

Comments:
-Recommended as alternative therapy for penicillin-allergic patients with early stage infection (primary, secondary, and early-latent syphilis); if cannot ensure compliance or follow-up, penicillin-allergic patients should be desensitized and treated with benzathine penicillin G.
-The patient's sexual partner(s) should also be evaluated/treated.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Bacteremia:

1 month or older: 50 to 75 mg/kg IV or IM once a day (or in equally divided doses twice a day)
Maximum dose: 2 g/day

Uses: For the treatment of serious miscellaneous infections when due to susceptible organisms; may include:
-Bacterial septicemia due to S aureus, S pneumoniae, E coli, H influenzae, or K pneumoniae
-Bone and joint infections due to S aureus, S pneumoniae, E coli, P mirabilis, K pneumoniae, or Enterobacter species
-Urinary tract infections due to E coli, P mirabilis, P vulgaris, M morganii, or K pneumoniae

American Academy of Pediatrics (AAP) Recommendations:
Neonates: 50 mg/kg IV or IM every 24 hours

1 month or older:
Mild to moderate infections: 50 to 75 mg/kg IV or IM once a day
Maximum dose: 1 g/day

Severe infections: 100 mg/kg IV or IM once a day (or in equally divided doses twice a day)
Maximum dose: 2 to 4 g/day

Comments:
-Neonates should not receive this drug IV if they are receiving (or expected to receive) calcium-containing IV solutions (including parenteral nutrition).
-In patients at least 1 year of age, larger doses (up to 100 mg/day) appropriate for penicillin-resistant pneumococcal pneumonia.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Joint Infection:

1 month or older: 50 to 75 mg/kg IV or IM once a day (or in equally divided doses twice a day)
Maximum dose: 2 g/day

Uses: For the treatment of serious miscellaneous infections when due to susceptible organisms; may include:
-Bacterial septicemia due to S aureus, S pneumoniae, E coli, H influenzae, or K pneumoniae
-Bone and joint infections due to S aureus, S pneumoniae, E coli, P mirabilis, K pneumoniae, or Enterobacter species
-Urinary tract infections due to E coli, P mirabilis, P vulgaris, M morganii, or K pneumoniae

American Academy of Pediatrics (AAP) Recommendations:
Neonates: 50 mg/kg IV or IM every 24 hours

1 month or older:
Mild to moderate infections: 50 to 75 mg/kg IV or IM once a day
Maximum dose: 1 g/day

Severe infections: 100 mg/kg IV or IM once a day (or in equally divided doses twice a day)
Maximum dose: 2 to 4 g/day

Comments:
-Neonates should not receive this drug IV if they are receiving (or expected to receive) calcium-containing IV solutions (including parenteral nutrition).
-In patients at least 1 year of age, larger doses (up to 100 mg/day) appropriate for penicillin-resistant pneumococcal pneumonia.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Osteomyelitis:

1 month or older: 50 to 75 mg/kg IV or IM once a day (or in equally divided doses twice a day)
Maximum dose: 2 g/day

Uses: For the treatment of serious miscellaneous infections when due to susceptible organisms; may include:
-Bacterial septicemia due to S aureus, S pneumoniae, E coli, H influenzae, or K pneumoniae
-Bone and joint infections due to S aureus, S pneumoniae, E coli, P mirabilis, K pneumoniae, or Enterobacter species
-Urinary tract infections due to E coli, P mirabilis, P vulgaris, M morganii, or K pneumoniae

American Academy of Pediatrics (AAP) Recommendations:
Neonates: 50 mg/kg IV or IM every 24 hours

1 month or older:
Mild to moderate infections: 50 to 75 mg/kg IV or IM once a day
Maximum dose: 1 g/day

Severe infections: 100 mg/kg IV or IM once a day (or in equally divided doses twice a day)
Maximum dose: 2 to 4 g/day

Comments:
-Neonates should not receive this drug IV if they are receiving (or expected to receive) calcium-containing IV solutions (including parenteral nutrition).
-In patients at least 1 year of age, larger doses (up to 100 mg/day) appropriate for penicillin-resistant pneumococcal pneumonia.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Septicemia:

1 month or older: 50 to 75 mg/kg IV or IM once a day (or in equally divided doses twice a day)
Maximum dose: 2 g/day

Uses: For the treatment of serious miscellaneous infections when due to susceptible organisms; may include:
-Bacterial septicemia due to S aureus, S pneumoniae, E coli, H influenzae, or K pneumoniae
-Bone and joint infections due to S aureus, S pneumoniae, E coli, P mirabilis, K pneumoniae, or Enterobacter species
-Urinary tract infections due to E coli, P mirabilis, P vulgaris, M morganii, or K pneumoniae

American Academy of Pediatrics (AAP) Recommendations:
Neonates: 50 mg/kg IV or IM every 24 hours

1 month or older:
Mild to moderate infections: 50 to 75 mg/kg IV or IM once a day
Maximum dose: 1 g/day

Severe infections: 100 mg/kg IV or IM once a day (or in equally divided doses twice a day)
Maximum dose: 2 to 4 g/day

Comments:
-Neonates should not receive this drug IV if they are receiving (or expected to receive) calcium-containing IV solutions (including parenteral nutrition).
-In patients at least 1 year of age, larger doses (up to 100 mg/day) appropriate for penicillin-resistant pneumococcal pneumonia.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Bacterial Infection:

1 month or older: 50 to 75 mg/kg IV or IM once a day (or in equally divided doses twice a day)
Maximum dose: 2 g/day

Uses: For the treatment of serious miscellaneous infections when due to susceptible organisms; may include:
-Bacterial septicemia due to S aureus, S pneumoniae, E coli, H influenzae, or K pneumoniae
-Bone and joint infections due to S aureus, S pneumoniae, E coli, P mirabilis, K pneumoniae, or Enterobacter species
-Urinary tract infections due to E coli, P mirabilis, P vulgaris, M morganii, or K pneumoniae

American Academy of Pediatrics (AAP) Recommendations:
Neonates: 50 mg/kg IV or IM every 24 hours

1 month or older:
Mild to moderate infections: 50 to 75 mg/kg IV or IM once a day
Maximum dose: 1 g/day

Severe infections: 100 mg/kg IV or IM once a day (or in equally divided doses twice a day)
Maximum dose: 2 to 4 g/day

Comments:
-Neonates should not receive this drug IV if they are receiving (or expected to receive) calcium-containing IV solutions (including parenteral nutrition).
-In patients at least 1 year of age, larger doses (up to 100 mg/day) appropriate for penicillin-resistant pneumococcal pneumonia.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Urinary Tract Infection:

1 month or older: 50 to 75 mg/kg IV or IM once a day (or in equally divided doses twice a day)
Maximum dose: 2 g/day

Uses: For the treatment of serious miscellaneous infections when due to susceptible organisms; may include:
-Bacterial septicemia due to S aureus, S pneumoniae, E coli, H influenzae, or K pneumoniae
-Bone and joint infections due to S aureus, S pneumoniae, E coli, P mirabilis, K pneumoniae, or Enterobacter species
-Urinary tract infections due to E coli, P mirabilis, P vulgaris, M morganii, or K pneumoniae

American Academy of Pediatrics (AAP) Recommendations:
Neonates: 50 mg/kg IV or IM every 24 hours

1 month or older:
Mild to moderate infections: 50 to 75 mg/kg IV or IM once a day
Maximum dose: 1 g/day

Severe infections: 100 mg/kg IV or IM once a day (or in equally divided doses twice a day)
Maximum dose: 2 to 4 g/day

Comments:
-Neonates should not receive this drug IV if they are receiving (or expected to receive) calcium-containing IV solutions (including parenteral nutrition).
-In patients at least 1 year of age, larger doses (up to 100 mg/day) appropriate for penicillin-resistant pneumococcal pneumonia.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Meningitis:

1 month or older:
Initial dose: 100 mg/kg IV or IM at the start of therapy
Maximum dose: 4 g/dose

Maintenance dose: 100 mg/kg IV or IM once a day (or in equally divided doses every 12 hours)
Maximum dose: 4 g/day
Duration of therapy: 7 to 14 days

Comments:
-This drug has been effective in a limited number of cases of meningitis and shunt infection due to S epidermidis and E coli.

Use: For the treatment of meningitis due to H influenzae, N meningitidis, or S pneumoniae

IDSA Recommendations:
-Infants and children with bacterial meningitis: 80 to 100 mg/kg IV every 24 hours (or in equally divided doses every 12 hours) for 7 to at least 21 days
Maximum dose: 4 g/day

US CDC Recommendations:
-Neonates with DGI and documented meningitis: 25 to 50 mg/kg IV or IM every 24 hours for 10 to 14 days
-Adolescents with gonococcal meningitis: 1 to 2 g IV every 12 to 24 hours for 10 to 14 days

Comments:
-Duration of bacterial meningitis therapy should be based on isolated pathogen.
-A recommended regimen for DGI in neonates
-This drug should be used with caution in hyperbilirubinemic neonates, especially if premature.
-With azithromycin, the recommended regimen for gonococcal meningitis in adolescents; the patient's sexual partner(s) should also be evaluated/treated.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Otitis Media:

50 mg/kg IM as a single dose
Maximum dose: 1 g/dose

Uses: For the treatment of acute bacterial otitis media due to S pneumoniae, H influenzae (including beta-lactamase producing strains), or Moraxella catarrhalis (including beta-lactamase producing strains)

AAP Recommendations:
1 month or older: 50 mg/kg IM once a day
Maximum dose: 1 g/dose
Duration of therapy: 1 to 3 days

Usual Pediatric Dose for Skin and Structure Infection:

1 month or older: 50 to 75 mg/kg IV or IM once a day (or in equally divided doses twice a day)
Maximum dose: 2 g/day

Uses: For the treatment of skin and skin structure infections due to S aureus, S epidermidis, S pyogenes, viridans group streptococci, E coli, E cloacae, K oxytoca, K pneumoniae, P mirabilis, M morganii, P aeruginosa, S marcescens, A calcoaceticus, B fragilis, or Peptostreptococcus species

Usual Pediatric Dose for Pneumonia:

1 month or older: 50 to 75 mg/kg/day IV or IM in divided doses every 12 hours
Maximum dose: 2 g/day

Uses: For the treatment of serious miscellaneous infections when due to susceptible organisms; may include lower respiratory tract infections due to S pneumoniae, S aureus, H influenzae, H parainfluenzae, K pneumoniae, E coli, E aerogenes, P mirabilis, or S marcescens

US CDC, NIH, HIVMA/IDSA, Pediatric Infectious Diseases Society (PIDS), and AAP Recommendations for HIV-exposed and HIV-infected Children: 50 to 100 mg/kg IV or IM once a day (or in equally divided doses twice a day)
Maximum dose: 4 g/day

Comments:
-Recommended as a preferred regimen for bacterial pneumonia due to S pneumoniae (occasionally S aureus, H influenzae)
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Bronchitis:

1 month or older: 50 to 75 mg/kg/day IV or IM in divided doses every 12 hours
Maximum dose: 2 g/day

Uses: For the treatment of serious miscellaneous infections when due to susceptible organisms; may include lower respiratory tract infections due to S pneumoniae, S aureus, H influenzae, H parainfluenzae, K pneumoniae, E coli, E aerogenes, P mirabilis, or S marcescens

US CDC, NIH, HIVMA/IDSA, Pediatric Infectious Diseases Society (PIDS), and AAP Recommendations for HIV-exposed and HIV-infected Children: 50 to 100 mg/kg IV or IM once a day (or in equally divided doses twice a day)
Maximum dose: 4 g/day

Comments:
-Recommended as a preferred regimen for bacterial pneumonia due to S pneumoniae (occasionally S aureus, H influenzae)
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Intraabdominal Infection:

1 month or older: 50 to 75 mg/kg/day IV or IM in divided doses every 12 hours
Maximum dose: 2 g/day

Uses: For the treatment of serious miscellaneous infections when due to susceptible organisms; may include intraabdominal infections due to E coli, K pneumoniae, B fragilis, Clostridium species, or Peptostreptococcus species

IDSA and SIS Recommendations: 50 to 75 mg/kg IV once a day (or in equally divided doses twice a day)
Maximum dose: 2 g/day

Comments:
-With metronidazole, recommended for complicated community-acquired infection
-Dose should be maximized if undrained intraabdominal abscess may be present.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Gonococcal Infection -- Uncomplicated:

US CDC Recommendations:
Neonates (without signs of infection) born to mothers with gonococcal infection: 25 to 50 mg/kg IV or IM as a single dose
Maximum dose: 125 mg/dose

Infants and children weighing up to 45 kg: 25 to 50 mg/kg IV or IM as a single dose
Maximum dose: 125 mg/dose

Children weighing more than 45 kg and adolescents: 250 mg IM as a single dose

Comments:
-The recommended regimen for neonates without signs of gonococcal infection; mothers with gonorrhea and their sexual partner(s) should be evaluated/treated.
-This drug should be used with caution in hyperbilirubinemic neonates, especially if premature.
-The recommended regimen for children with uncomplicated gonococcal vulvovaginitis, cervicitis, urethritis, pharyngitis, or proctitis; no data regarding use of dual therapy. Children should be tested for syphilis, chlamydial infections, and HIV.
-With azithromycin, the recommended regimen for uncomplicated infections of the pharynx, cervix, urethra, and rectum in adolescents; preferable to administer this drug and azithromycin simultaneously and under direct observation. Suspected treatment failures should first be retreated with the recommended regimen as reinfections more likely than treatment failures. The patient's sexual partner(s) should also be evaluated/treated.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Gonococcal Infection -- Disseminated:

US CDC Recommendations:
Neonates:
-DGI or gonococcal scalp abscesses: 25 to 50 mg/kg IV or IM every 24 hours

Duration of therapy: 7 days
-If meningitis documented: 10 to 14 days

Children:
-Arthritis or bacteremia:
45 kg or less: 50 mg/kg IV or IM every 24 hours for 7 days
Maximum dose: 1 g/day

Greater than 45 kg: 1 g IV or IM once a day for 7 days

Adolescents:
-Arthritis and arthritis-dermatitis syndrome: 1 g IV or IM every 24 hours
-Gonococcal endocarditis and meningitis: 1 to 2 g IV every 12 to 24 hours

Duration of therapy:
-Arthritis-dermatitis syndrome: At least 7 days (total)
-Gonococcal endocarditis: At least 4 weeks
-Gonococcal meningitis: 10 to 14 days

Comments:
-A recommended regimen for DGI and gonococcal scalp abscesses in neonates
-This drug should be used with caution in hyperbilirubinemic neonates, especially if premature.
-The recommended regimen for DGI in children; no data regarding use of dual therapy. Children should be tested for syphilis, chlamydial infections, and HIV.
-With azithromycin, the recommended regimen for DGI in adolescents; the patient's sexual partner(s) should also be evaluated/treated.
-Hospitalization and consultation with an infectious disease specialist recommended for initial therapy, particularly for adolescents who may be noncompliant with therapy, have an uncertain diagnosis, or have purulent synovial effusions/other complications; patients should be examined for clinical signs of endocarditis and meningitis.
-Arthritis-dermatitis syndrome in adolescents: Can switch to oral therapy (guided by antimicrobial susceptibility testing) 24 to 48 hours after significant clinical improvement
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Meningococcal Meningitis Prophylaxis:

US CDC Recommendations:
Less than 15 years: 125 mg IM as a single dose
15 years or older: 250 mg IM as a single dose

Usual Pediatric Dose for Endocarditis:

AHA and IDSA Recommendations for Pediatric Patients:
Infection due to viridans group streptococci, S bovis, or HACEK microorganisms or documented Bartonella endocarditis (culture positive): 100 mg/kg IV or IM every 24 hours
Maximum dose: 2 g/day

Duration of therapy:
-Native valve infection due to viridans group streptococci, S bovis, or HACEK microorganisms: 4 weeks
-Prosthetic valve (or other prosthetic material) infection due to viridans group streptococci, S bovis, or HACEK microorganisms: 6 weeks
-Documented Bartonella endocarditis (culture positive): 6 weeks

Native or prosthetic valve infection due to E faecalis strains resistant to penicillin, aminoglycosides, and vancomycin: 50 mg/kg IV or IM every 12 hours for at least 8 weeks
Maximum dose: 4 g/day

US CDC Recommendations for Adolescents:
Gonococcal endocarditis: 1 to 2 g IV every 12 to 24 hours for at least 4 weeks

Comments:
-Recommended for patients with normal renal function
-Native valve infection due to highly penicillin-susceptible viridans group streptococci or S bovis: If this drug is used with gentamicin, the duration of therapy may be reduced to 2 weeks; 2-week regimen not recommended if known cardiac/extracardiac abscess, CrCl less than 20 mL/min, impaired 8th cranial nerve function, or Abiotrophia, Granulicatella, or Gemella species infection.
-Native valve infection due to viridans group streptococci or S bovis relatively resistant to penicillin: This drug should be used with gentamicin.
-Prosthetic valve (or other prosthetic material) infection due to viridans group streptococci or S bovis: This drug may be used with or without gentamicin if penicillin-susceptible strain (MIC up to 0.12 mcg/mL); not recommended for relatively/fully penicillin-resistant strain (MIC greater than 0.12 mcg/mL).
-HACEK microorganisms include H parainfluenzae, A aphrophilus, A actinomycetemcomitans, C hominis, E corrodens, and K kingae.
-Documented Bartonella endocarditis (culture positive): This drug should be used with gentamicin; infectious diseases specialist should be consulted.
-Native/prosthetic valve infection due to E faecalis strains resistant to penicillin, aminoglycosides, and vancomycin: This drug should be used with ampicillin.
-Gonococcal endocarditis in adolescents: This drug should be used azithromycin (the recommended regimen); the patient's sexual partner(s) should also be evaluated/treated.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Bacterial Endocarditis Prophylaxis:

AHA and IDSA Recommendations:
Children: 50 mg/kg IV or IM as a single dose 30 to 60 minutes before dental procedure
Maximum dose: 1 g/dose

Comments:
-Recommended as an alternative in patients, with or without penicillin/ampicillin allergy, unable to take oral medication (unless history of anaphylaxis, angioedema, or urticaria with penicillins or ampicillin)
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Lyme Disease:

AAN and IDSA Recommendations: 50 to 75 mg/kg IV once a day
Maximum dose: 2 g/day
Duration of therapy: 14 days

Comments:
-IDSA recommends this drug as the preferred parenteral regimen for early neurologic disease (meningitis or radiculopathy), cardiac disease, and late disease (recurrent arthritis after oral regimen, central or peripheral nervous system disease).
-Duration of therapy has ranged from 10 to 28 days.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Salmonella Enteric Fever:

US CDC, NIH, and HIVMA/IDSA Recommendations for HIV-infected Adolescents: 1 g IV every 24 hours

Duration of Salmonellosis Therapy:
For gastroenteritis without bacteremia:
-If CD4 count at least 200 cells/mm3: 7 to 14 days
-If CD4 count less than 200 cells/mm3: 2 to 6 weeks

For gastroenteritis with bacteremia:
-If CD4 count at least 200 cells/mm3: 14 days; longer if persistent bacteremia or complicated infection (e.g., metastatic foci of infection present)
-If CD4 count less than 200 cells/mm3: 2 to 6 weeks

Comments:
-Recommended as alternative empiric therapy for bacterial enteric infections (pending diagnostic studies) and as alternative therapy for salmonella gastroenteritis with or without bacteremia
-Empiric therapy for bacterial enteric infections recommended for patients with advanced HIV (CD4 count less than 200 cells/mm3 or concomitant AIDS-defining illnesses) and clinically severe diarrhea (at least 6 stools/day or bloody stool) and/or associated fever/chills. Fecal samples should be obtained for diagnostic testing before starting therapy; therapy should be adjusted based on those results.
-All HIV-infected patients with salmonellosis should receive antibiotic therapy; increased risk of bacteremia (by 20- to 100-fold) and mortality (by up to 7-fold) compared to HIV-negative subjects.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Salmonella Gastroenteritis:

US CDC, NIH, and HIVMA/IDSA Recommendations for HIV-infected Adolescents: 1 g IV every 24 hours

Duration of Salmonellosis Therapy:
For gastroenteritis without bacteremia:
-If CD4 count at least 200 cells/mm3: 7 to 14 days
-If CD4 count less than 200 cells/mm3: 2 to 6 weeks

For gastroenteritis with bacteremia:
-If CD4 count at least 200 cells/mm3: 14 days; longer if persistent bacteremia or complicated infection (e.g., metastatic foci of infection present)
-If CD4 count less than 200 cells/mm3: 2 to 6 weeks

Comments:
-Recommended as alternative empiric therapy for bacterial enteric infections (pending diagnostic studies) and as alternative therapy for salmonella gastroenteritis with or without bacteremia
-Empiric therapy for bacterial enteric infections recommended for patients with advanced HIV (CD4 count less than 200 cells/mm3 or concomitant AIDS-defining illnesses) and clinically severe diarrhea (at least 6 stools/day or bloody stool) and/or associated fever/chills. Fecal samples should be obtained for diagnostic testing before starting therapy; therapy should be adjusted based on those results.
-All HIV-infected patients with salmonellosis should receive antibiotic therapy; increased risk of bacteremia (by 20- to 100-fold) and mortality (by up to 7-fold) compared to HIV-negative subjects.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for STD Prophylaxis:

US CDC Recommendations:
Adolescents: 250 mg IM as a single dose

Comments:
-With azithromycin and (metronidazole or tinidazole), the recommended regimen for presumptive therapy after sexual assault
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Conjunctivitis:

US CDC Recommendations:
Adolescents: 1 g IM as a single dose

Comments:
-With azithromycin, the recommended regimen for gonococcal conjunctivitis
-Consultation with an infectious disease specialist and a one-time lavage of the infected eye with saline solution should be considered.
-The patient's sexual partner(s) should also be evaluated/treated.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Ocular Infection:

US CDC Recommendations:
Neonates: 25 to 50 mg/kg IV or IM as a single dose
Maximum dose: 125 mg/dose

Comments:
-The recommended regimen for gonococcal ophthalmia neonatorum
-An infectious disease specialist should be consulted.
-This drug should be used with caution in hyperbilirubinemic neonates, especially if premature.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Chancroid:

AAP Recommendations:
1 month or older: 50 mg/kg IM as a single dose
Maximum dose: 250 mg/dose

Usual Pediatric Dose for Surgical Prophylaxis:

ASHP, IDSA, SIS, and SHEA Recommendations:
1 year or older:
Preoperative dose: 50 to 75 mg/kg IV as a single dose, starting within 60 minutes before surgical incision
Maximum dose: 2 g/dose

Comments:
-A single prophylactic dose is usually sufficient; if prophylaxis is continued postoperatively, duration should be less than 24 hours.
-Readministration may be needed for unusually long procedures to ensure adequate serum and tissue drug levels.
-Redosing may be needed if drug half-life is shortened (e.g., extensive burns) or if prolonged/excessive bleeding during surgery; redosing may not be needed if drug half-life is prolonged (e.g., renal dysfunction).
-Pediatric dose should not exceed adult dose.
-Current guidelines should be consulted for additional information.

Uses: For surgical prophylaxis for the following procedures:
-Biliary tract (recommended regimen): Open procedure and elective, high-risk laparoscopic procedure; should limit to patients requiring antimicrobial therapy for acute cholecystitis or acute biliary tract infections (which may not be established before incision), not patients undergoing cholecystectomy for noninfected biliary conditions (including biliary colic or dyskinesia without infection)
-Colorectal (with metronidazole, as a recommended regimen)

What other drugs will affect ceftriaxone?

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Where can I get more information?

  • Your doctor or pharmacist can provide more information about ceftriaxone.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
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