Standard dosing regimen
Intravenous, intramuscular.
Adults and children over 12 years of age >50 kg: 1-2 g once a day (every 24 hours). In severe cases or infections, the causative agents of which have only moderate sensitivity to ceftriaxone, the daily dose can be increased to 4 g. Duration of treatment depends on the course of the disease. As always with antibiotic therapy, the administration of Rocefin® should be continued for at least 48-72 hours after the temperature is normalized and the eradication of the pathogen is confirmed.
Usually the course of treatment is 4-14 days; with complicated infections, a longer duration of administration may be required.
The course of treatment for infections caused by Streptococcus pyogenes, should not be
less than 10 days.
Introduction
The general rule should be the use of solutions immediately after preparation. The 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 efficacy or tolerability of the preparation.
For intramuscular injection 250 mg or 500 mg of the drug Rocefin® is dissolved in 2 ml, a1 g. in 3.5 ml of a 1% solution of lidocaine and injected deeply into a sufficiently large muscle (buttock). It is recommended to inject no more than 1 g into the same muscle. The solution containing lidocaine, can not be administered intravenously.
For intravenous injection Dissolve 250 mg or 500 mg of the drug Rocefin ® in 5 ml, and 1 g - in 10 ml of sterile water for injection; is administered intravenously slowly for 5 minutes, preferably in a large vein.
Intravenous infusion should last at least 30 minutes. To prepare the solution, 2 g of Rocefin® is dissolved in 40 ml of one of the following infusion solutions that do not contain calcium ions: 0.9% sodium chloride solution, 0.45% sodium chloride solution + 2.5% dextrose solution, 5% dextrose solution, 10% dextrose solution,6% dextran solution in 5% dextrose solution, 6-10% solution of hydroxyethyl starch, water for injections. Solutions of the preparation Rocefin® can not mixed or added to solutions containing other antimicrobial agents or other solvents, with the exception of those listed above, because of the possible incompatibility.
Solvents containing calcium, such as Ringer's solution or Hartmann's solution, can not be used for the preparation of solutions of Rocefin® for intravenous administration and their subsequent dilution, because of the possible formation of precipitates. The formation of precipitates of calcium salts of ceftriaxone can also occur when mixing the preparation of Rocefin® and calcium-containing solutions using a single venous access. Do not use Rocefin® concomitantly with calcium-containing solutions for intravenous administration, including long-term infusions of calcium-containing solutions, for example, with parenteral nutrition using Y-connector. For all groups of patients, except for newborns, it is possible to consistently administer the preparation of Rocefin® and calcium-containing solutions with thorough washing of infusion systemsbetween infusions of a compatible liquid (see section "Interaction with other drugs").
Not there have been reports of interaction between ceftriaxone and oral calcium-containing drugs or the interaction of ceftriaxone for intramuscular administration and calcium-containing drugs (for intravenous or oral use).
Dosing in special cases
Patients with impaired hepatic function
In patients with impaired liver function, there is a need to reduce the dose provided there are no violations of kidney function.
Patients with dysfunction of night
In patients with impaired renal function, there is no need to reduce the dose provided there are no violations of liver function. The daily dose of the drug Rocefin® should not exceed 2 g only in cases of renal failure with a creatinine clearance less than 10 ml / min. Ceftriaxone is not excreted in hemodialysis or peritoneal dialysis, therefore, the patient is not required to administer an additional dose of Rocefin® after the end of dialysis.
When combination of severe renal and hepatic insufficiency should carefully monitor the effectiveness and safety of the drug.
Patients of elderly and senile age
Usual doses for adults without age adjustments, provided there is no severe renal and hepatic insufficiency.
Children
Newborns, infants and children under 12 years of age
When appointing the drug Rocefin ® once a day, it is recommended to adhere to the following dosing regimens:
- newborns (up to 14 days): 20-50 mg / kg body weight once a day; daily dose should not exceed 50 mg / kg of body weight;
- newborns, infants and young children (from 15 days to 12 years): 20-80 mg / kg body weight once a day;
- Children weighing more than 50 kg are prescribed doses for adults.
Preterm infants up to 41 weeks of age (cumulatively gestational and chronological age) are not eligible for pepetrioxone. Rocefin® is contraindicated in newborns (<28 days) who have already been prescribed or are expected to receive intravenous calcium-containing solutions, including long-term calcium-containing infusions, for example, with parenteral nutrition due to the risk of calcium precipitates formation of ceftriaxone (see "Contraindications" section)
For infants and children under 12 years of age, intravenous doses of 50 mg / kg or higher should be given drip for at least 30 minutes. Newborn intravenous administration should be performed within 60 minutes to reduce the potential risk of developing bilirubin encephalopathy.
Meningitis
When bacterial meningitis in infants and young children treatment starts with a dose of 100 mg / kg (but not more than 4 g) 1 time per day. After identifying the pathogen and determining its sensitivity, the dose can be reduced accordingly. The best results with meningococcal meningitis were achieved with a treatment duration of 4 days, with meningitis caused by Haemophilus influenzae - 6 days, Streptococcus pneumoniae - 7 days.
Lyme disease
50 mg / kg (the highest daily dose is 2 g) for adults and children once a day for 14 days.
Gonorrhea (caused by penicillin-forming and penicillin-zoned strains)
Single intramuscular injection of 250 mg of Rocefin® to adult patients and children over 12 years of age >50 kg.
Acute otitis media
When treating acute otitis media in children, we recommend a single intramuscular injection at a dose of 50 mg / kg (but not more than 1 g).
Adults are recommended a single intramuscular injection in a dose of 1-2 g.According to limited data, in severe cases or with ineffectiveness of previous therapy. the drug Rocefin® can be effective when administered intramuscularly at a dose of 1-2 g per day for 3 days.
Prevention of postoperative infections
Depending on the degree of infectious risk, 1-2 g of the drug Rocefin® is administered once for 30-90 min before the operation. In operations on the colon and rectum, the administration of the preparation Rocefin® and one of the 5-nitroimidazoles, for example, ornidazole, has proved to be simultaneous (but separate, see the section "Dosing and Administration").