How to breed ceftriaxone for intramuscular and intravenous administration, instructions for the use of antibiotics

To achieve the maximum therapeutic effect in the process of antimicrobial treatment of a wide range of infectious pathologies, you need to know exactly how to breed ceftriaxone, an antibiotic drug of the third generation of cephalosporins, which has high chemotherapeutic activity. The medicine can destroy many types of pyogenic microorganisms, showing increased resistance to special enzymes - lactamases, which produce harmful bacteria to weaken the effectiveness of the antibiotic.

The composition of the drug

The tool is produced in the form of a white powder containing a therapeutic substance - ceftriaxone sodium. The powder is used to obtain a medicinal solution used for drip and jet injections intravenously or injections into the muscle.

The drug is delivered to pharmacies in transparent, hermetically sealed glass vials with 500, 1000 mg of the active ingredient.

Pharmacological properties and indications for use

Healing properties

Ceftriaxone has a powerful antimicrobial effect - it destroys harmful microorganisms, destroying their cell membrane. The medication is able to suppress many different kinds of bacteria, including aerobic and anaerobic forms, gram-positive and gram-negative species.

The therapeutic substance is actively distributed with the blood stream, easily entering all organs, including cerebral and bone tissue, and fluids, including intraarticular, spinal and pleural. In human milk, about 4% of the amount of a therapeutic substance in the blood plasma is found.

Bioavailability, that is, the amount of ceftriaxone sodium reaching the abnormal focus is almost 100%.

The maximum concentration in the blood is noted 90 to 120 minutes after an intramuscular injection, and with intravenous infusion, at the end of the procedure.

The therapeutic substance can be in the body for a long time, retaining its antimicrobial effect for 24 hours or more.

The half-life of the drug (the time of losing half of the pharmacological activity) is 6-8 hours, and in older patients from 70 years it lengthens up to 16 hours, in infants from a month of life - up to 6.5 days, in newborns - up to 8 days.

For the most part (up to 60%), ceftriaxone is removed with urine, and partially with bile.

With poor renal function, the removal of the therapeutic substance slows down, and therefore, its accumulation in the tissues is possible.

When appointed

With the help of this antibiotic medication, inflammatory pathologies are caused by microbial agents that respond to the antibacterial activity of ceftriaxone.

Among them are infections:

• stomach, urine and biliary organs, reproductive system, intestines (pyelonephritis, epididymitis, cystitis, cholangitis, prostatitis, peritonitis, empyema of the gallbladder, urethritis);
• lungs, bronchi and ENT organs (pneumonia, purulent otitis media, bronchitis, agranulocytic tonsillitis, purulent sinusitis, pulmonary abscess, pleural empyema);
• skin, bones, subcutaneous tissue, joints (osteomyelitis, streptoderma, burns and wounds affected by pathogenic microbial flora);

In addition, Ceftriaxone with a pronounced therapeutic effect treats:

• bacterial damage to the meninges (meningitis) and the inner lining of the heart (endocarditis);
• uncomplicated gonococcal infection, syphilis; dysentery, tick-borne borreliosis;
• septicemia when pyogenic bacteria and their poisons get into the blood; purulent-septic pathologies arising in the form of postoperative complications;
• typhoid, acute intestinal lesion by salmonella;
• infections that occur against a background of weakened immunity.

How to breed ceftriaxone for intravenous and intramuscular administration

Intravenous administration

Important! Lidocaine is not allowed for intravenous infusion of ceftriaxone. Before injecting the drug into a vein, the powder is diluted exclusively with injection water.

Syringe Infusion

Intravenous infusion of drugs with a syringe is done very slowly - within 2 to 4 minutes.

To inject 1000 mg of antibiotic into a vein, 10 ml of sterile water is added to a bottle with 1 gram of the drug.

To obtain a dose of 250 or 500 mg, a powder from a 0.5 g vial is diluted with water for injection in a volume of 5 ml. 500 mg will be in a full bottle, and 250 mg of the therapeutic substance in half the volume of the finished solution.

Infusion using a dropper (infusion)

Drip infusions are carried out if the patient requires a dosage calculated at a rate of 50 mg (or more) of an antibiotic per kilogram of patient weight.

Important! It is forbidden to dissolve ceftriaxone in any medicinal fluids containing calcium.

When setting the dropper, 2 grams of the drug is diluted with 40 - 50 ml of saline - 9% NaCl or 5 - 10% dextrose (glucose).

An intravenous drip should last no less than half an hour.

Intramuscular injections

How to dissolve Ceftriaxone powder, and which solvents can be used to reduce soreness during an injection?

In order to dilute the antibiotic to the desired concentration, injectable water (usually in hospitals) and painkillers are used. But Ceftriaxone injections, if the drug is diluted with water, are quite painful, so doctors are urged recommend dissolving the medicine with anesthetic 1% lidocaine solution. And use sterile water only to dilute the anesthetic with a concentration of 2%.

But if the patient is allergic to anesthetics, in particular, to lidocaine, the powder will have to be diluted exclusively with water for injection, in order to prevent an acute anaphylactic reaction.

Novocaine is not suitable for diluting an antibiotic, because this anesthetic reduces the therapeutic activity of Ceftriaxone, and more often than lidocaine, it causes acute allergies and shock and relieves soreness worse.

How to dilute Ceftriaxone lidocaine 1%:

If you want to enter 500 mg, the medicine from the vial with a dosage of 0.5 g is dissolved in 2 ml of 1% lidocaine (1 ampoule). If there is only a bottle with a dose of 1 gram, then it is diluted with 4 ml of anesthetic and exactly half of the resulting solution (2 ml) is taken into the syringe.

To introduce a dose of 1 gram, the powder from a 1 g vial is diluted with 3.5 ml of anesthetic. You can take not 3.5 but 4 ml, because it is more convenient and even less painful. If there are 2 vials with a dose of 0.5 grams, then 2 ml of anesthetic is added to each of them, then collecting the entire volume equal to 4 ml from each into a single syringe.

Important! It is not allowed to introduce into the buttock more than 1 gram of dissolved medication.

To obtain a dose of ceftriaxone 250 mg (0.25 g), a powder from a 500 mg vial is diluted in 2 ml of lidocaine and half of the prepared solution (1 ml) is drawn into a syringe.

Proper antibiotic dilution with 2% lidocaine

Units in grams		Enter in a bottle, ml		Collect the solution from the vial into the syringe, ml
Bottle	Dose required	Lidocaine 2%	Water for injections
1	1	1,8	1,8	3,6
1	0,5	1,8	1,8	1.8 (half bottle)
1	0,25	1,8	1,8	0,9
0,5	0,5	1	1	2
0,5	0,25	1	1	1 ml - half a bottle

If you want to get a dose of 1 gram, and there are 2 bottles of 0.5 g each, then you need to mix 2 ml of water and Lidocaine 2% in a syringe, then inject 2 ml of anesthetic-water mixture into each bottle. Then draw a solution from one and the other vial into the syringe (total 4 ml) and make an injection.

To minimize pain:

• intramuscular injection should be done very slowly;
• if possible, use a freshly prepared medicinal solution - this will reduce discomfort and give the maximum therapeutic effect.

If the prepared volume of the solution is enough for 2 injections, it is allowed to store the diluted powder in the room for no longer than 6, and in the refrigerator for up to 20-24 hours. But an injection with a stored solution will be more painful than a freshly prepared medicine. If the stored solution has changed color, then you can not do an injection, since this symptom indicates its instability.

It is advisable to use two needles for one injection. An anesthetic or water is introduced through the first needle into the vial and the resulting solution is collected. Then they change the needle to a sterile one and only after that make an injection.

Instructions for use of the antibiotic

The duration of antimicrobial therapy is determined by the type of infectious disease and the severity of the clinical picture. After reducing the severity of painful manifestations and temperature, doctors recommend prolonging the use of pharmaceuticals for at least another 3 days.

Adults

Patients from 12 years old on average receive 2 injections per day (with an interval of 10 - 12 hours) at 0.5 - 1 gram (that is, per day - from 1 to 2 g). With severe diseases, the dose is increased to 4 grams per day.

To treat uncomplicated gonococcal infection in adults, 250 mg of ceftriaxone is once injected into the muscle. In the treatment of purulent otitis media, a single dose is 50 mg per kilogram of body weight (not more than 1 gram).

In order to prevent purulent postoperative inflammation 30 to 120 minutes before surgery, the patient is given an intravenous drip of 1 to 2 g of the antibiotic for 20 to 30 minutes (with an average antibiotic concentration of 10 to 40 mg in 1 ml of saline for infusion).

Children

For children from one year to 12 years old, the daily dose is calculated based on the norm of 20 - 75 mg per kilogram of the child's weight.The resulting dosage is divided into 2 injections with an interval of 12 hours.

For example, a 2-year-old child weighing 16 kg per day will require a minimum of 20 x 16 = 320 mg of the drug, a maximum of 75 x 16 = 1200 mg. Severe infectious processes require a maximum norm of 75 mg per kg per day, but even in this case, the greatest amount of antibiotic that a young patient can receive per day is limited to 2 grams.

In case of infection of the skin and subcutaneous tissues, ceftriaxone treatment is carried out according to the scheme: per day, the child receives either 1 injection at a calculated dose of 50 - 75 mg per kilogram or 2 injections are given to him (after 12 hours), introducing a dose of 25 - 37.5 mg per kg

Newborns, including premature babies from 2 weeks of age, are prescribed a medication, calculating the daily children's dose according to the scheme: 20 - 50 mg per kg of baby's weight.

If the baby is diagnosed with bacterial meningitis, the child is injected once a day at the rate of 100 mg per kg of weight. The duration of therapy depends on the type of pathogen and can range from 4 to 5 days (if meningococcus is detected) to 2 weeks if enterobacteria are detected.

When the weight of a minor patient reaches 50 kg (even if he is under 12 years old), the drug is prescribed in adult doses.

Features:

1. Patients with impaired renal function during normal liver function do not need to reduce the dose of the antibiotic. But in severe renal failure (CC below 10 ml / min), the daily amount of the drug is limited to 2 grams. If the patient undergo hemodialysis, you can not adjust the dosage.
2. Patients with hepatic pathology amid normal kidney function, the injection dose of the drug is also not required to reduce.
3. With a simultaneously occurring serious impairment of kidney and liver functions, it is necessary to periodically check the level of ceftriaxone in the blood serum.

Contraindications, side effects and overdose

Ceftriaxone antibiotic is not allowed to prescribe:

• with severe allergies to ceftriaxone, other cephalosporins, penicillins, carbopenems;
• patients up to 12 to 13 weeks of gestation;
• nursing mothers (for the duration of therapy, the baby is transferred to breastfeeding);
• newborns receiving intravenous infusions of calcium-containing solutions, against the background of an abnormally high level of bilirubin in the blood;
• patients with severe kidney and liver failure at the same time (strictly according to indications).

With caution, the medication is used in the treatment of:

• premature infants, newborns with high bilirubin in the blood, patients with drug and food allergies,
• pregnant patients after 12 weeks of gestation;
• patients with ulcerative colitis, provoked previously by antibacterial treatment;
• elderly and debilitated people.

Most patients tolerate Ceftriaxone treatment well.

In some cases, it is possible:

• the appearance of itchy skin rash, blisters, chills, swelling of the eyelids, tongue, lips, larynx (in case of contraindications for patients with allergies);
• nausea, vomiting, loose stools, taste disturbance, gas formation;
• "Thrush" (candidiasis) of the mucous membrane of the mouth, tongue, genitals;
• inflammation of the oral mucosa and tongue (stomatitis, glossitis);
• headache, sweating, fever on the face;
• cholestatic jaundice, hepatitis, pseudomembranous colitis;
• phlebitis (inflammation of the vessel), pain at the injection site;
• decreased urine output (oliguria), non-infectious pyelonephritis;
• acute pain in the right hypochondrium due to pseudo-cholelithiasis of the gallbladder;
• anemia.

With long-term treatment with high doses, a change in laboratory blood parameters is possible:

• increased or decreased white blood cell count;
• increased activity of liver enzymes, alkaline phosphatases, creatinine;
• very rarely - a change in blood coagulability, including both a decrease in platelet count (hypoprothrombinemia) and the appearance of blood in the urine and nosebleeds, and an abnormally high platelet count (thrombocytosis) with a risk of thrombosis.

Urine contains a high content of urea and sugar (glucosuria).

Taking large doses of the antibiotic within 3 to 4 weeks can cause signs of overdose, which are manifested in the appearance or amplification of these unwanted adverse reactions. In this case, the cancellation of the medication and the appointment of pharmaceuticals that eliminate the emerging negative signs are required. Blood purification techniques, including hemo- and peritoneal dialysis, with an overdose do not give a positive result.

Parallel use with other pharmaceuticals

It is forbidden to mix Ceftriaxone with other types of antibiotic medicines in the same syringe or bottle for drip intravenous infusion.

With the combination of ceftriaxone:

• with anticoagulants and drugs that reduce the process of platelet adhesion (Sulfinpyrazone, Warfarin, anti-inflammatory, acetylsalicylic acid), there is an increase in their action and an increase in the risk of bleeding;
• with loop diuretics - increases the likelihood of kidney damage.

It is interesting:acne salicylic acid - how to apply