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Dose and indication of ceftrioxon +salbactum?

Responses (1)

Rajive Goel 8 Aug 2012

Ceftriaxone induces filamentation in Escherichia coli and Pseudomonas
aeruginosa, it binds primarily to PBP 3 which is responsible for formation of
cross-wall or septum of dividing bacilli. Ceftriaxone has a high degree of stability against the beta-lactamases, both penicillinases and cephalosporinases produced by both gram -ve and gram +ve bacteria but not against chromosomally and plasmid mediated ESBL's produced by some strains of Klebsiella, Escherichia coli, Enterobacter spp and Serratia spp.
Sulbactam irreversibly blocks the destruction of beta-lactam ring of Ceftriaxone
by these wide variety of ESBLs and chromosomally mediated beta-lactamases
by attaching to these enzymes and acting as a suicide substrate that forms a
stable intermediate, rendering the enzyme inactive.

Sulbactam is a broader-spectrum beta-lactamase inhibitor than clavulanic acid.
Sulbactam does not induce chromosomal beta-lactamases like clavulanic acid,
nor does it select for derepressed beta-lactamase-producing bacteria. Thus the full potential of Ceftriaxone against Klebsiella, pseudomonas, Eschericia coli spp is restored by addition of Sulbatam.

The combination of Ceftriaxone sodium and Sulbactam sodium is active against all the organisms sensitive to Ceftriaxone. In addition it demonstrates
synergistic activity (reduction in minimum inhibitory concentrations, for the
combination versus those of each component) in a variety of organisms.
Gram-Negative Aerobes
Acinetobacter calcoaceticus; Enterobacter aerogenes; Enterobacter cloacae; Escherichia coli; Haemophilus influenzae (including ampicillin-resistant and beta-lactamase; producing strains); Haemophilus parainfluenzae; Klebsiella oxytoca; Klebsiella pneumoniae; Moraxella catarrhalis (including beta-lactamase producing strains); Morganella morganii; Neisseria gonorrhoeae (including penicillinase - and nonpenicillinaseproducing
strains); Neisseria meningitidis; Proteus mirabilis; Proteus vulgaris; Serratia marcescens.

Ceftriaxone is also active against many strains of Pseudomonas aeruginosa.
Many strains of the above organisms that are resistant to other antibiotics, eg,
penicillins, cephalosporins and aminoglycosides, are susceptible to Ceftriaxone. Ceftriaxone also demonstrates in vitro activity against most strains of the following microorganism like Citrobacter diversus , Citrobacter freundii,
Providencia species (including Providencia rettgeri , Salmonella species
(including S. typhi), Shigella species Gram-Positive Aerobes

Staphylococcus aureus (including penicillinase-producing strains and methicillin sensitive strains but not methicillin resistant strains); Staphylococcus epidermidis; Streptococcus pneumoniae; Streptococcus pyogenes; Viridans group streptococci;

Anaerobes: Bacteroides fragilis, Clostridium species , Peptostreptococcus species.

Ceftriaxone + Sulbactum treatment of following infections when caused by
susceptible bacteria. Meningitis; For treatment of Nosocomial infections surgical prophylaxis; Urinary tract infections (complicated by underlying urological abnormalities); Skin and soft tissue infections Like cellulites, erysepalis etc.; Cholecystitis; Osteomyelitis; Sexually transmitted diseases (Gonorrhoea, Chancroid, Syphilis); Chronic suppurative bacterial otitis media; Infections in dialysis unit.

Adults
The usual adult daily dose (in terms of Ceftriaxone) is 1-2 grams given once a day (or in equally divided doses twice a day) depending on the type and severity of the infection. The total daily dose should not exceed 4 grams.
Dosage regimen for Ceftriaxone-Sulbactam should be adjusted in
patients with marked decrease in renal function (creatinine clearance of <
30ml/min) and to compensate for reduced clearance less than 15ml/min patient should receive a maximum of 500mg of sulbactam every 12 hours(maximum dose 1 gram of sulbactam)

Paediatric patients
For treatment of Skin and Soft tissue infections the recommended total daily
dose (in terms of Ceftriaxone) is 50-75mg/kg given once a day or (in equally
divided doses twice a day). The total daily dose should not exceed 1 gram.
For treatment of acute bacterial otitis media: A single intramuscular dose of 50 mg/kg (not to exceed 1gram) is recommended. In treatment of Meningitis: The initial therapeutic dose in terms of Ceftriaxone should
be 100 mg/kg (not to exceed 4 grams) Daily dose may be administered once a day or in equally divided doses 12 hourly. The usual duration of therapy is 7-14 days. For treatment of serious infections other than meningitis: Recommended total daily dose in terms of Ceftriaxone is 50-75 mg/kg given in divided doses every 12 hrs. The total daily dose (in terms of Ceftriaxone) should not exceed more than 2 grams.

However do talk to a pharmacist/doc who may have prescribed the med. Take care.

Best wishes!

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