|Systematic (IUPAC) name|
|Trade names||Rocephin or Epicephin, Arixon, Elcefrin(LGls)|
|Pregnancy cat.||B1 (AU) B (US)|
|Legal status||Prescription Only (S4) (AU)|
|Excretion||33–67% renal, 35–45% biliary|
|Mol. mass||554.58 g/mol|
|(what is this?)|
Ceftriaxone (INN) // is an antibiotic useful for the treatment of a number of bacterial infections. It is a third-generation cephalosporin. Like other third-generation cephalosporins, it has broad-spectrum activity against Gram-positive bacteria and expanded Gram-negative coverage compared to second-generation agents. In most cases, it is considered to be equivalent to cefotaxime in terms of safety and efficacy. Ceftriaxone sodium is marketed by Hoffmann-La Roche under the trade name Rocephin.
It is on the World Health Organization's List of Essential Medicines, a list of the most important medication needed in a basic health system.
Ceftriaxone is used to treat a wide variety of serious infections caused by organisms that are resistant to most other antibiotics. It is often used (in combination, but not direct, with macrolide and/or aminoglycoside antibiotics) for the treatment of community-acquired or mild to moderate health care-associated pneumonia.
It is also a choice drug for treatment of bacterial meningitis caused by pneumococci, meningococci, Haemophilus influenzae, and susceptible enteric gram-negative rods, but not Listeria monocytogenes.
Other uses included the treatment of acute bacterial otitis media, skin and skin structure infections, bone and joint infections, intra-abdominal and urinary tract infections, pelvic inflammatory disease (PID), uncomplicated gonorrhea, and bacterial septicemia. It also approved to be used in surgical (perioperative) prophylaxis.
Pregnancy category B. Ceftriaxone has not been observed to cause birth defects in animal studies, and preliminary studies in humans have shown no increase risk for birth defects.
Low concentrations of ceftriaxone are excreted in breast milk. The manufacturer recommends that caution be exercised when administering ceftriaxone to nursing women.
Ceftriaxone may precipitate in bile, causing biliary sludge and gallstones, especially in children. It may cause allergic reactions similar to those caused by penicillin. Due to the 3-8% cross allergenicity with penicillins, patients with a history of anaphylaxis, urticaria, or angioedema to penicillin should not receive ceftriaxone or any other cephalosporin. Other common side effects include local irritation at the injections site, rash, and diarrhea. Hypoprothrombinaemia and bleeding are specific side-effects. Haemolysis is reported. It has also been reported to cause post renal failure in children.
Ceftriaxone should not be used in those with an allergy to ceftriaxone or any component of the formulation. It should not be used in hyperbilirubinemic neonates, particularly those who are premature because ceftriaxone is reported to displace bilirubin from albumin binding sites. It is contraindicated with concomitant use with intravenous calcium-containing solutions/products in neonates (≤28 days)  even if administered through different infusion lines due to rare fatal cases of calcium-ceftriaxone precipitations in neonatal lungs and kidneys.
Spectrum of activity
Like other third-generation cephalosporins, ceftriaxone is active against citrobacter, S. marcenscens, and beta-lactamase-producing strains of haemophilus and neisseria. However, unlike ceftazidime and cefoperazone, ceftriaxone does not have useful activity against Pseudomonas aeruginosa. It is not generally not active against enterobacter species, and its use should be avoided in the treatment of enterobacter infections even if the isolate appears susceptible because of the emergence of resistance. Like all other cephalosporins, it has no activity against enterococci, atypicals (Mycoplasma and Chlamydia), or Listeria.
Mechanism of Action
Ceftriaxone inhibits bacterial cell wall synthesis by means of binding to the penicillin-binding proteins (PBPs). Inhibition of PBPs would in turn inhibit the transpeptidation step in peptidoglycan synthesis which is required for bacterial cell walls. Like other cephalosporins, ceftriaxone is bacteriocidal and exhibits time-dependent killing.
The half-life is 7–8 hours. Like other third-generation cephalosporins, ceftriaxone penetrates body fluids and tissues well, and can achieve levels in the cerebrospinal fluid sufficient to inhibit most pathogens. The excretion is mainly through the biliary track and no dose adjustment is required in renal impairment. With the exception cefoperazone, all other third-generation cephalosporins require dose adjustment in renal insufficiency.
Ceftriaxone can be administered intravenously and intramuscularly. It is not available orally. For most infections, ceftriaxone can be injected once every 24 hours at a dosage of 15–50 mg/kg/d. A single daily 1-g dose is usually sufficient. A dose of 2-g every 12 hours is recommended for the treatment of meningitis. A single intramuscular dose of 250 mg is recommended for the treatment of gonorrheal urethritis and cervicitis in conjunction with a single 1-g oral dose of azithromycin or doxycycline 100 mg orally twice daily for seven days to cover chlamydia co-infection. According to the Journal of Family Practice, Volume 60, NO 12, December 2011, the intramuscular dose of ceftriaxone (Rocephin) has been increased from 125 mg IM to 250 mg IM due to increasing resistance of the gonococcal bacteria. The dosage for acute ear infection in the very young is 50 mg/kg IM, one dose daily up to three days.
Ceftriaxone is a white crystalline powder readily soluble in water, sparingly soluble in methanol, and very slightly soluble in ethanol. The pH of a 1% aqueous solution is approximately 6.7.
The syn-configuration of the methoxyimino moiety confers resistance to β-lactamase enzymes produced by many Gram-negative bacteria. The stability of this configuration results in increased activity of ceftriaxone against otherwise-resistant Gram-negative bacteria. In place of the easily hydrolysed acetyl group of cefotaxime, ceftriaxone has a metabolically stable thiotriazinedione moiety.
Ceftriaxone has also been investigated for efficacy in preventing relapse to cocaine addiction.
Ceftriaxone has been shown to have neuroprotective properties in a number of neurological disorders, including spinal muscular atrophy and amyotrophic lateral sclerosis. Despite earlier negative results in the 1990s, a large clinical trial was undertaken in 2006 to test ceftriaxone in ALS patients but was stopped early after it became clear that the results would not meet the pre-determined criteria for efficacy. 
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