Popular analogues
Ceftriaxone substitutes are included in the subgroup of cephalosporins; they contain the same active component. The selection of analogues is carried out by the attending physician, taking into account the causes of adverse reactions to therapy.
1. Lorakson
The medicine is indicated for the treatment of diseases caused by pathogenic microflora:
- peritonitis, meningitis, infections due to immune dysfunction;
- inflammation of the bronchi and lungs;
- tonsillitis, sinusitis, pharyngitis, sinusitis;
- cholecystitis, paraproctitis, pancreatitis.
The drug is suitable for the treatment of lesions of bone, joint, soft tissue and dermis. Loraxone is used to prevent secondary infections in the postoperative period.
2. Sulbactomax
The medication is used for infections:
- respiratory department;
- skin;
- urinary system;
- urogenital tract;
- bone and joint tissues.
Admission is approved for patients with immunodeficiencies and cancer - to prevent secondary infectious processes. The drug is prescribed in the preoperative and postoperative period.
Nosological classification (ICD-10)
- A41.8 Other specified septicemia
- A49.9 Bacterial infection, unspecified
- A54.9 Gonococcal infection, unspecified
- D84.9 Immunodeficiency, unspecified
- G00 Bacterial meningitis, not elsewhere classified
- H60 Otitis externa
- H66 Suppurative and unspecified otitis media
- J01 Acute sinusitis
- J03.9 Acute tonsillitis, unspecified (angina agranulocytic)
- J06 Acute upper respiratory tract infections of multiple and unspecified localization
- J18 Pneumonia without specifying the pathogen
- J22 Acute respiratory infection of the lower respiratory tract, unspecified
- K65 Peritonitis
- K83.0 Cholangitis
- K92.9 Disease of the digestive system, unspecified
- L08.9 Local infection of skin and subcutaneous tissue, unspecified
- M89.9 Bone disease, unspecified
- N12 Tubulointerstitial nephritis, not specified as acute or chronic
- N39.0 Urinary tract infection without established location
- N49 Inflammatory diseases of the male genital organs, not elsewhere classified
- N73.9 Inflammatory diseases of the female pelvic organs, unspecified
- N74.3 Gonococcal inflammatory diseases of the female pelvic organs (A54.2+)
- T81.4 Infection associated with procedure, not elsewhere classified
Expensive substitutes
The list of good, but high-cost products includes Azaran and Rocephin. The drugs are recommended for the treatment of minors due to rare cases of side effects, manifested by:
- breathing problems, cough;
- obsessive itching, dermatological rash, red spots;
- nettle fever, serum sickness, anaphylaxis.
During therapy there are no unpleasant sensations in the gastrointestinal tract or changes in the composition of the blood.
Directions for use and doses
IM, IV.
Adults and children over 12 years old. The average daily dose is 1–2 g of ceftriaxone once a day or 0.5–1 g every 12 hours.
In severe cases or in cases of infections caused by moderately sensitive pathogens, the daily dose can be increased to 4 g.
Newborns. For a single daily dosage, the following regimen is recommended: for newborns (up to 2 weeks of age): 20–50 mg/kg/day (it is not recommended to exceed a dose of 50 mg/kg due to the immature enzyme system of newborns).
Infants and children under 12 years of age. The daily dose is 20–75 mg/kg. In children weighing 50 kg or more, the adult dosage should be followed. Doses greater than 50 mg/kg should be given as an IV infusion over at least 30 minutes.
The duration of therapy depends on the course of the disease.
Meningitis. For bacterial meningitis in newborns and children, the initial dose is 100 mg/kg 1 time per day (maximum 4 g). Once the pathogen has been isolated and its sensitivity has been determined, the dose must be reduced accordingly.
The best results were achieved with the following periods of therapy:
| Pathogen | Duration of therapy, days |
| Neisseria meningitidis | 4 |
| Haemophilus influenzae | 6 |
| Streptococcus pneumoniae | 7 |
| susceptible Enterobacteriaceae | 10–14 |
Gonorrhea. For the treatment of gonorrhea caused by both penicillinase-forming and non-penicillinase-forming strains, the recommended dose is 250 mg once intramuscularly.
Prevention in the pre- and postoperative period. Before infected or suspected infected surgical procedures, to prevent postoperative infections, depending on the risk of infection, a single administration of ceftriaxone in a dose of 1–2 g is recommended 30–90 minutes before surgery.
Failure of kidney and liver function. In patients with impaired renal function, provided that liver function is normal, there is no need to reduce the dose of ceftriaxone. Only in case of renal failure in the preterminal stage (Cl creatinine <10 ml/min) is it necessary that the daily dose of ceftriaxone does not exceed 2 g.
In patients with impaired liver function, provided that renal function is preserved, there is also no need to reduce the dose of ceftriaxone.
In cases of simultaneous presence of severe liver and kidney pathology, the concentration of ceftriaxone in the blood serum must be regularly monitored. In patients undergoing hemodialysis, there is no need to change the dose of the drug after this procedure.
IM injection. For intramuscular administration, 1 g of the drug must be diluted in 3.5 ml of a 1% lidocaine solution and injected deep into the gluteal muscle; it is recommended to inject no more than 1 g of the drug into one buttock. Lidocaine solution should never be administered intravenously.
IV administration. For IV injection, 1 g of the drug must be diluted in 10 ml of sterile distilled water and administered IV slowly over 2–4 minutes.
IV infusion. The duration of the IV infusion is at least 30 minutes. For intravenous infusion, 2 g of the drug must be diluted in approximately 40 ml of a calcium-free solution, for example, 0.9% sodium chloride solution, 5% dextrose solution, 10% dextrose solution, 5% fructose solution.
Injection analogues
Popular substitutes for Ceftriaxone in the form of injections are presented:
- Cefazolin - used to combat infections of the skin and soft tissues, and prevent postoperative complications. For adults, 1-2 g is prescribed up to three times a day, for children - from 50 to 80 mg per kilogram of weight, for 2-3 daily procedures.
- Cefuroxime is a drug used for the treatment of community-acquired pneumonia, diseases of the genitourinary tract, and in surgical practice. The medication is prescribed in a dosage of 2.25 to 4.5 g three times a day, for children - from 50 to 100 mg per kilogram of weight, up to 4 times a day.
- Cefotaxime is a strong antibiotic that suppresses the activity of streptococcal infections. The drug is approved for newborns and is prescribed for meningitis and hospital-acquired infectious pathologies. Dosed at 3-4 g up to four doses per day, for children - from 50 to 100 mg per kilogram of weight, up to 6 procedures daily.
- Ceftazidime – fights Pseudomonas aeruginosa, is used for low white blood cell levels. The medicine is not used for streptococci, 3-6 g is prescribed up to 3 procedures per day, for children - from 3 to 100 mg/kg, the drug is administered after 6 hours.
- Cefoperazone - may cause adverse reactions such as bleeding. The active components are excreted through the liver and do not penetrate into the brain tissue well. Adults are recommended to take 4-12 g of medication, divided into 4 procedures, children - from 50 to 100 mg/kg, the total amount is divided into 3 procedures.
- Cefepime is a fourth-generation antibiotic that suppresses the activity of pathogens resistant to certain cephalosporins. It is used for patients with a weakened body, with a complex course of infectious processes provoked by several types of bacteria. Adults are prescribed 2 to 4 g twice a day, children - 50 mg/kg, three times a day.
The above dosages are intended for daily injections. The total amount is divided into several doses, observing the intervals between injections recommended by the instructions.
Instructions for use CEFTRIAXONE
Adults and children over 12 years of age:
Usually 1-2 g of Ceftriaxone is prescribed 1 time / day (every 24 hours). For severe infections or infections whose pathogens are only moderately sensitive to ceftriaxone, the daily dose can be increased to 4 g.
Children
Newborns (up to 2 weeks):
20-50 mg/kg body weight 1 time/day. Considering the underdevelopment of the enzyme system, the daily dose should not exceed 50 mg/kg body weight. There are no differences when determining the dose for full-term and premature infants.
Ceftriaxone is contraindicated in neonates ≤28 days of age who need (or are expected to need) treatment with calcium-containing IV solutions, including calcium-containing IV infusions such as parenteral nutrition, due to the risk of calcium salt precipitates ceftriaxone.
Children from 15 days to 12 years:
20-80 mg/kg body weight 1 time/day. Children weighing more than 50 kg are prescribed doses as for adults.
IV doses of 50 mg/kg or higher should be administered by infusion over at least 30 minutes.
A dose of more than 80 mg/kg body weight should not be prescribed due to the increased risk of biliary precipitation.
Elderly patients
Elderly patients do not require dose adjustment.
Duration of treatment
The duration of antibacterial treatment depends on the course of the disease. Patients should continue to take Ceftriaxone for at least 48-72 hours after the temperature has normalized and/or confirmation of eradication of pathogens has been obtained.
Combination therapy
Studies have shown that there is a synergism between ceftriaxone and aminoglycosides against many gram-negative bacteria. Although the increased effectiveness of such combinations cannot always be predicted, it should be considered in the presence of severe, life-threatening infections caused by Pseudomonas aeruginosa. Due to the physical incompatibility of ceftriaxone and aminoglycosides, they should be administered separately at recommended doses.
Dosing in special cases
Meningitis
For bacterial meningitis in children aged 15 days to 12 years, treatment begins with a dose of 100 mg/kg (but not more than 4 g) 1 time/day. Once the pathogen has been identified and its sensitivity established, the dose can be reduced accordingly. The best results were achieved with the following treatment duration:
- Neisseria meningitidis - 4 days;
- Haemophilus influenza - 6 days;
- Streptococcus pneumoniae - 7 days.
Gonorrhea
For the treatment of gonorrhea (caused by penicillinase-forming or non-penicillinase-forming strains), a single dose of 250 mg IM is recommended.
Prevention of infections in surgery
To prevent postoperative infections in surgery, it is recommended, depending on the degree of danger of infection, to administer a single dose of 1-2 g of Ceftriaxone 30-90 minutes before the start of surgery. During operations on the colon and rectum, the simultaneous (but separate) administration of the drug and one of the 5-nitroimidazoles, for example ornidazole, has worked well.
Kidney and liver failure
In patients with impaired renal function, there is no need to reduce the dose if liver function remains normal. Only in case of end-stage renal failure (creatinine clearance less than 10 ml/min) the daily dose should not exceed 2 g.
In case of simultaneous severe renal and liver failure, the concentration of ceftriaxone in the blood plasma should be regularly determined and the dose of the drug adjusted if necessary.
Patients on hemodialysis do not need additional administration of the drug after dialysis. However, the serum concentration of ceftriaxone should be monitored in relation to possible dose adjustments, since the elimination rate may be reduced in such patients. The daily dose of Ceftriaxone in patients on hemodialysis should not exceed 2 g.
Preparation of solutions
Prepare solutions immediately before use.
Freshly prepared solutions retain their physical and chemical stability for 6 hours at room temperature (or for 24 hours at a temperature of 2-8°C). Depending on the concentration and duration of storage, the color of solutions can vary from pale yellow to amber. The color of the solution does not affect the effectiveness or tolerability of the drug.
Injection
For injection, dissolve 1 g in 3.5 ml of 1% lidocaine solution; make the injection deep into the gluteal muscle. It is recommended to inject no more than 1 g into one buttock. If the indicated dose exceeds 1 g, it should be divided and administered in multiple injections.
IV injection
For injection, dissolve 1 g of the drug in 10 ml of sterile water for injection, administer intravenously slowly (2-4 minutes).
Introduction
The administration should last at least 30 minutes. To prepare a solution for infusion, dissolve 2 g of Ceftriaxone in 40 ml of one of the following infusion solutions free of calcium ions:
- 0.9% sodium chloride, 0.45% sodium chloride + 2.5% glucose, 5% glucose, 10% glucose, 6% dextran in 5% glucose solution, 6-10% hydroxyethyl starch, water for injection. Due to possible incompatibility, solutions containing ceftriaxone should not be mixed with solutions containing other antibiotics, either during preparation or during administration.
Solvents containing calcium, such as Ringer's solution or Hartmann's solution, should not be used to dissolve the drug in vials or to dilute the reconstituted solution for intravenous administration due to the possibility of the formation of precipitates of ceftriaxone calcium salts. Precipitates of ceftriaxone calcium salts can also occur when ceftriaxone is mixed with solutions containing calcium in the same infusion system for intravenous administration.
Ceftriaxone should not be coadministered with solutions containing calcium, including long-term infusions containing calcium, such as parenteral nutrition.
