Ceftriaxone Injection: Uses, Dosage, Side Effects & Nursing Guidelines

 

💉 Introduction:

Ceftriaxone is a broad-spectrum, third-generation cephalosporin antibiotic that plays a crucial role in treating moderate to severe bacterial infections. It is widely used in hospitals due to its bactericidal action and long half-life, making once-daily dosing possible.

This article breaks down everything nurses and healthcare students need to know—from indications and mechanisms to side effects and nursing responsibilities.

💊 Generic Name:

Ceftriaxone Sodium

💼 Trade Name:

• Rocephin

• Cefaxone

• Ceftron

• Triax

🧪 Class / Action:

• Pharmacologic Class: Third-generation cephalosporin

• Therapeutic Class: Antibiotic

• Action: Bactericidal; inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs).

💉 Route / Dosage:

Common Routes:

• Intravenous (IV)

• Intramuscular (IM)

Dosage (Adult):

• 1–2 g once daily or in two divided doses

• Up to 4 g/day depending on infection severity

Dosage (Pediatric):

• 50–100 mg/kg/day once daily or in divided doses

Always adjust dose based on renal/hepatic function and infection severity.

⚠️ High Alert Medication:

NO

Although not a high-alert drug, caution is advised in neonates and patients with hepatic/renal impairment.

💡 Indications:

1. Respiratory tract infections (e.g., pneumonia)
2. Skin and soft tissue infections
3. Urinary tract infections (UTI)
4. Bone and joint infections
5. Meningitis
6. Septicemia
7. Intra-abdominal infections
8. Gonorrhea
9. Surgical prophylaxis
10. Pelvic inflammatory disease (PID)

🔬 Mechanism of Action:

Ceftriaxone works by inhibiting bacterial cell wall synthesis, resulting in cell lysis and death. It binds to specific penicillin-binding proteins (PBPs), disrupting the cross-linking of peptidoglycans which provide the bacterial cell wall its strength.

🚫 Contraindications:

1. Known allergy to cephalosporins or penicillins
2. Neonates with hyperbilirubinemia (risk of kernicterus)
3. Concurrent use with calcium-containing IV solutions in neonates
4. Severe hepatic or renal impairment (without dose adjustment)

⚠️ Adverse Reactions / Side Effects:

Common:

1. Pain at injection site
2. Diarrhea
3. Nausea/vomiting
4. Rash
5. Fever

Serious:

1. Anaphylaxis
2. Pseudomembranous colitis
3. Hemolytic anemia
4. Superinfection (e.g., C. difficile)
5. Seizures (especially in renal impairment)
6. Gallbladder sludge and biliary pseudolithiasis

🩺 Nursing Implications:

1. Assess for allergies to penicillin or cephalosporins before administration.
2. Monitor WBC count, liver and renal function tests, and PT/INR during prolonged therapy.
3. Ensure IV administration is slow over 30–60 minutes to reduce risk of phlebitis.
4. Rotate IM injection sites; consider lidocaine for IM pain relief.
5. Watch for signs of superinfection (fever, thrush, diarrhea).
6. Report diarrhea, especially if bloody or with abdominal pain, which may signal C. difficile.
7. Monitor neonates and infants closely due to risk of bilirubin displacement.

🧑‍⚕️ Patient Education:

1. Advise patients to complete the full course even if symptoms improve early.
2. Report any rash, itching, breathing problems, or diarrhea immediately.
3. Encourage adequate hydration to support renal function.
4. Instruct not to self-inject unless properly trained.
5. For women: Notify the nurse or doctor if pregnant or breastfeeding.

📋 Notes for Nurses:

1. Avoid mixing with calcium-containing solutions (like Ringer’s lactate) in neonates.
2. Therapeutic drug monitoring is generally not required but always assess renal and hepatic status.
3. May cause false-positive Coombs' test or urine glucose tests—inform lab or physician.
4. Evaluate patient regularly for clinical improvement (e.g., reduced fever, WBC count, localized symptoms).
5. Store reconstituted solutions as per manufacturer’s guidelines—usually 24 hrs in refrigerator.
6. Rotate IV sites, especially in long-term therapy, to avoid phlebitis.