CeftriaxoneNursing considerations

Side effects by what to assess

Sources: [1][2][3][4]

Blood glucose

Why

Some blood glucose meters read falsely low; non-enzymatic urine glucose tests read falsely positive

When

During therapy in patients who check glucose

Act on

Use alternative or enzymatic testing methods if needed

Normal

Fasting 70 to 99 mg/dL.

Sources: [1][2]

INR (prothrombin time)

Why

Prothrombin time changes and bleeding risk with vitamin K antagonists

When

In impaired vitamin K synthesis or low stores (chronic liver disease, malnutrition); often with warfarin, during and after treatment

Act on

If the prothrombin time is prolonged, vitamin K 10 mg weekly may be needed; adjust the anticoagulant dose

Normal

INR 0.8 to 1.1 when not on a blood thinner. On warfarin, the usual target is 2.0 to 3.0.

Sources: [1][2]

Serum creatinine

Why

Dose limit with combined renal and hepatic disease; urinary precipitates and post-renal failure

When

In severe renal or hepatic dysfunction

Act on

With both hepatic dysfunction and significant renal disease, do not exceed 2 grams per day

Normal

0.7 to 1.3 mg/dL in men and 0.5 to 0.95 mg/dL in women.

Sources: [1][2]

High-alert status

Ceftriaxone is not on the ISMP acute care high-alert list.

Sources: [1]

Narrow therapeutic index

The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.

Sources: [1]

Boxed warning

None on the current label.

Sources: [1]

Antidote or reversal

No specific antidote. Stop the drug and give symptom-based supportive care. Hemodialysis and peritoneal dialysis do not lower levels. Overdose in severe renal impairment has caused encephalopathy and seizures.

Sources: [1]

Patient teaching

• Tell the nurse about any past reaction to cephalosporins, penicillins, or other antibiotics
• Report confusion, unusual sleepiness, muscle jerks, or seizures at once
• Report rash, hives, swelling, or trouble breathing right away
• Watery or bloody stools, even 2 or more months later, need prompt medical attention
• Antibiotics treat only bacterial infections; complete the full course even when feeling better
• Some home glucose meters may read falsely low during treatment; ask before relying on them

Sources: [1][2][3]

Sound-alike and look-alike names

• cefTRIAXone and ceFAZolin

Sources: [1]

Adult dose

Usual adult dose, IV or IM

1 to 2 grams once daily, or the same total split into two doses. Do not exceed 4 grams per day.

Uncomplicated gonorrhea

250 mg IM, one dose. Add chlamydia coverage if Chlamydia is suspected.

Surgical prophylaxis

A single 1 gram IV dose given from half an hour to 2 hours before surgery.

Sources: [1]

Renal adjustment

None at usual doses, since ceftriaxone is cleared by both bile and kidneys. Not removed by dialysis, so no extra dose is needed afterward. With both hepatic dysfunction and significant renal disease, do not exceed 2 grams per day. Watch for neurologic toxicity in severe renal impairment.

Sources: [1][2][3]

Hepatic adjustment

None for hepatic dysfunction alone. With both hepatic dysfunction and significant renal disease, do not exceed 2 grams per day. Monitor the prothrombin time in chronic liver disease.

Sources: [1][2]

Mechanism

Bactericidal beta-lactam that blocks bacterial cell wall synthesis. It stays active against some beta-lactamases from gram-negative and gram-positive bacteria. It reaches inflamed meninges, and its long half-life (about 6 to 9 hours in adults) allows once-daily dosing. It is cleared through both bile and urine.

Sources: [1][2][3]