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Ceftriaxone: Wikis

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Ceftriaxone
Systematic (IUPAC) name
(6R,7R)-7-{[(2Z)-2-(2-amino-1,3-thiazol-4-yl)->2-(methoxyimino)acetyl]amino}-3-{[(2-methyl-5,6-dioxo-1,2,5,6-tetrahydro-1,2,4-triazin-3-yl)thio]methyl}-8-oxo-5-thia-1-azabicyclo[4.2.0]oct-2-ene-2-carboxylic acid
Identifiers
CAS number 73384-59-5
ATC code J01DD01
PubChem 5479530
DrugBank APRD00395
ChemSpider 4586394
Chemical data
Formula C 18H18N8O7S3  
Mol. mass 554.58 g/mol
SMILES eMolecules & PubChem
Pharmacokinetic data
Bioavailability n/a
Metabolism Negligible
Half life 5.8–8.7 hours
Excretion 33–67% renal, 35–45% biliary
Therapeutic considerations
Pregnancy cat. B1(AU) B(US)
Legal status Prescription Only (S4) (AU)
Routes Intravenous, intramuscular
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Ceftriaxone (INN) (pronounced /ˌsɛftraɪˈæksoʊn/) is a third-generation cephalosporin antibiotic. Like other third-generation cephalosporins, it has broad spectrum activity against Gram-positive and Gram-negative bacteria. In most cases, it is considered to be equivalent to cefotaxime in terms of safety and efficacy. Ceftriaxone sodium is marketed by Hoffman-La Roche under the trade name Rocephin, as well as under various other names in several countries.

Contents

Clinical use

Ceftriaxone 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. In pediatrics, it is commonly used in febrile infants between 4 and 8 weeks of age who are admitted to the hospital to exclude sepsis. The dosage for acute ear infection in the very young is 50 mg/Kg IM, one dose only. It has also been used in the treatment of Lyme disease, typhoid fever and gonorrhea.

Intravenous dosages may be adjusted for body mass in younger patients and is administered every 12–24 hours, at a dose that depends on the type and severity of the infection.

For the treatment of gonorrhea, a single intramuscular injection is usually given. Treatment for chlamydia infection is also recommended (usually with azithromycin) unless it is specifically ruled out.[1]

It must not be mixed or administered simultaneously (within 48 hours) with calcium-containing solutions or products, even via different infusion lines (rare fatal cases of calcium-ceftriaxone precipitates in lung and kidneys in neonates have been described).[2]

To reduce the pain of intramuscular injection, ceftriaxone may be reconstituted with 1% lidocaine.[3]

Ceftriaxone has also been investigated for efficacy in preventing relapse to cocaine addicition.[4]

Chemistry

Ceftriaxone is a yellowish-orange crystalline powder which is 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 stability to β-lactamase enzymes produced by many Gram-negative bacteria. Such stability to β-lactamases increases the 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.

References

  1. ^ Barclay, Laurie (April 16, 2007). "CDC issues new treatment recommendations for gonorrhea". Medscape. http://cme.medscape.com/viewarticle/555228. Retrieved 2009-07-01.  
  2. ^ Bradley JS, Wassel RT, Lee L, Nambiar S (April 2009). "Intravenous ceftriaxone and calcium in the neonate: assessing the risk for cardiopulmonary adverse events". Pediatrics 123 (4): e609–13. doi:10.1542/peds.2008-3080. PMID 19289450.  
  3. ^ Schichor A, Bernstein B, Weinerman H, Fitzgerald J, Yordan E, Schechter N (January 1994). "Lidocaine as a diluent for ceftriaxone in the treatment of gonorrhea. Does it reduce the pain of the injection?". Arch Pediatr Adolesc Med 148 (1): 72–5. PMID 8143016.  
  4. ^ Knackstedt LA, Melendez RI, Kalivas PW (August 2009). "Ceftriaxone Restores Glutamate Homeostasis and Prevents Relapse to Cocaine Seeking". Biol Psychiatry. doi:10.1016/j.biopsych.2009.07.018. PMID 19717140.  

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