Ceftrifin Uses

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What is Ceftrifin?

Ceftrifin is used to treat bacterial infections in many different parts of the body. Ceftrifin is also given before certain types of surgery to prevent infections.

Ceftrifin belongs to the class of medicines known as cephalosporin antibiotics. It works by killing bacteria or preventing their growth. However, Ceftrifin will not work for colds, flu, or other virus infections.

Ceftrifin is available only with your doctor's prescription.

Ceftrifin indications

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Before instituting treatment with B Braun Ceftrifin, appropriate specimens should be obtained for isolation of the causative organism and for determination of its susceptibility to the drug. Therapy may be instituted prior to obtaining results of susceptibility testing.

To reduce the development of drug-resistant bacteria and maintain the effectiveness of B Braun Ceftrifin and other antibacterial drugs, B Braun Ceftrifin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

B Braun Ceftrifin is indicated for the treatment of the following infections when caused by susceptible organisms: Lower respiratory tract infections caused by Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Escherichia. coli, Enterobacter aerogenes, Proteus mirabilis or Serratia marcescens.

Skin and skin structure infections caused by Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes, Viridans group streptococci, Escherichia coli, Enterobacter cloacae, Klebsiella oxytoca, Klebsiella pneumoniae, Proteus mirabilis, Morganella morganii*, Pseudomonas aeruginosa, Serratia marcescens, Acinetobacter calcoaceticus, Bacteroides fragilis* or Peptostreptococcus spp.

Urinary tract infections (complicated and uncomplicated) caused by Escherichia coli, Proteus mirabilis, Proteus vulgaris, Morganella morganii or Klebsiella pneumoniae.

Pelvic inflammatory disease caused by Neisseria gonorrhoeae. Ceftrifin sodium, like other cephalosporins, has no activity against Chlamydia trachomatis. Therefore, when cephalosporins are used in the treatment of patients with pelvic inflammatory disease and Chlamydia trachomatis is one of the suspected pathogens, appropriate antichlamydial coverage should be added.

Bacterial septicemia caused by Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, Haemophilus influenzae or Klebsiella pneumoniae.

Bone and joint infections caused by Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae or Enterobacter spp.

Intra-abdominal infections caused by Escherichia coli, Klebsiella pneumoniae, Bacteroides fragilis, Clostridium spp (Note: Most strains of Clostridium difficile are resistant) or Peptostreptococcus spp.

Meningitis caused by Haemophilus influenzae, Neisseria meningitidis or Streptococcus pneumoniae.

Ceftrifin sodium has also been used successfully in a limited number of cases of meningitis and shunt infection caused by Staphylococcus epidermidis* and Escherichia coli*.

*Efficacy for this organism in this organ system was studied in fewer than 10 infections.

Surgical Prophylaxis: The preoperative administration of a single 1 g dose of B Braun Ceftrifin may reduce the incidence of postoperative infections in patients undergoing surgical procedures classified as contaminated or potentially contaminated (eg, vaginal or abdominal hysterectomy or cholecystectomy for chronic calculous cholecystitis in high-risk patients eg, those >70 years of age, with acute cholecystitis not requiring therapeutic antimicrobials, obstructive jaundice or common duct bile stones) and in surgical patients for whom infection at the operative site would present serious risk (eg, during coronary artery bypass surgery). Although Ceftrifin sodium has been shown to have been as effective as cefazolin in the prevention of infection following coronary artery bypass surgery, no placebo-controlled trials have been conducted to evaluate any cephalosporin antibiotic in the prevention of infection following coronary artery bypass surgery.

When administered prior to surgical procedures for which it is indicated, a single 1 g dose of B Braun Ceftrifin provides protection from most infections due to susceptible organisms throughout the course of the procedure.

How should I use Ceftrifin?

Use Ceftrifin as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Ask your health care provider any questions you may have about how to use Ceftrifin.

Uses of Ceftrifin in details

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Use: Labeled Indications

Bloodstream infection: Caused by Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, Haemophilus influenzae, or Klebsiella pneumoniae.

Bone and joint infections (osteomyelitis and/or discitis, prosthetic joint infection, septic arthritis): Caused by S. aureus, S. pneumoniae, E. coli, Proteus mirabilis, K. pneumoniae, or Enterobacter spp.

Gonococcal infection, uncomplicated (cervical/urethral, rectal, and pharyngeal): Caused by Neisseria gonorrhoeae, including both penicillinase- and nonpenicillinase-producing strains, and pharyngeal gonorrhea caused by nonpenicillinase-producing strains of N. gonorrhoeae.

Intra-abdominal infection, community-acquired (mild to moderate infection in low-risk patients): Caused by E. coli, K. pneumoniae, Bacteroides fragilis, Clostridium spp. (Note: Most strains of C. difficile are resistant), or Peptostreptococcus spp.

Lower respiratory tract infections (pneumonia, community-acquired): Caused by S. pneumoniae, S. aureus, H. influenzae, Haemophilus parainfluenzae, K. pneumoniae, E. coli, Enterobacter aerogenes, P. mirabilis, or Serratia marcescens.

Meningitis, bacterial: Caused by H. influenzae, Neisseria meningitidis, or S. pneumoniae. Ceftrifin has also been used successfully in a limited number of cases of meningitis and shunt infection caused by Staphylococcus epidermidis and E. coli (efficacy for these 2 organisms in this organ system was studied in fewer than 10 infections).

Otitis media, acute: Caused by S. pneumoniae, H. influenzae (including beta-lactamase-producing strains), or Moraxella catarrhalis (including beta-lactamase-producing strains).

Pelvic inflammatory disease (mild to moderate): Caused by N. gonorrhoeae. Ceftrifin, like other cephalosporins, has no activity against Chlamydia trachomatis; therefore, when cephalosporins are used in the treatment of patients with pelvic inflammatory disease and C. trachomatis is one of the suspected pathogens, appropriate antichlamydial coverage should be added.

Skin and soft tissue infections: Caused by S. aureus, S. epidermidis, Streptococcus pyogenes, viridans group streptococci, E. coli, Enterobacter cloacae, Klebsiella oxytoca, K. pneumoniae, P. mirabilis, Morganella morganii (efficacy for this organism in this organ system was studied in fewer than 10 infections), S. marcescens, Acinetobacter calcoaceticus, B. fragilis (efficacy for this organism in this organ system was studied in fewer than 10 infections), or Peptostreptococcus spp.

Surgical prophylaxis, colorectal: To reduce the incidence of postoperative infections in patients undergoing surgical procedures classified as contaminated or potentially contaminated.

Urinary tract infection, complicated (including pyelonephritis): Caused by E. coli, P. mirabilis, Proteus vulgaris, M. morganii, or K. pneumoniae.

Off Label Uses

Actinomycosis, severe or extensive

Data from a limited number of patients suggest Ceftrifin may be beneficial for the treatment of severe or extensive actinomycosis.

Ceftrifin description

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B Braun Ceftrifin is a sterile, nonpyrogenic, single use, packaged combination of Ceftrifin sodium and dextrose injection (diluent) in the Duplex sterile container. The Duplex container is a flexible dual chamber container.

The drug chamber is filled with Ceftrifin sodium, a sterile, semisynthetic, broad-spectrum cephalosporin antibiotic for IV administration. Ceftrifin sodium is (6R,7R)-7-[2-(2-Amino-4-thiazolyl)glyoxylamido]-8-oxo-3-[[(1,2,5,6-tetrahydro-2-methyl-5,6-dioxo-as-triazin-3-yl)thio]methyl]-5-thia-1-azabicyclo[4.2.0]oct-2-ene-2-carboxylic acid, 72-(Z)-(O-methyloxime), disodium salt, sesquaterhydrate.

Its chemical formula is C18H16N8Na2O7S3·3.5H2O. It has a calculated molecular weight of 661.6.

Ceftrifin sodium is supplied as a dry powder form equivalent to either 1 or 2 g of Ceftrifin. It is a white to 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 color of Ceftrifin sodium solutions ranges from light yellow to amber, depending on the length of storage and concentration.

Ceftrifin sodium contains approximately 83 mg (3.6 mEq) of sodium per gram of Ceftrifin activity.

The diluent chamber contains dextrose injection. The concentration of hydrous dextrose in water for injection USP has been adjusted to render the reconstituted drug product iso-osmotic. Dextrose USP has been added to adjust osmolality (approximately 1.87 g and 1.11 g to 1 g and 2 g dosages, respectively). Dextrose injection is sterile, nonpyrogenic, and contains no bacteriostatic or antimicrobial agents.

The molecular weight of hydrous dextrose USP is 198.17.

After removing the peelable foil strip, activating the seals, and thoroughly mixing, the reconstituted drug product is intended for single IV use. When reconstituted, the approximate osmolality for the reconstituted solution for B Braun Ceftrifin is 290 mOsmol/kg.

The Duplex container is latex-free, PVC-free, and DEHP-free.

The Duplex dual chamber container is made from a specially formulated material. The product (diluent and drug) contact layer is a mixture of thermoplastic rubber and a polypropylene ethylene copolymer that contains no plasticizers. The safety of the container system is supported by USP biological evaluation procedures.

Ceftrifin dosage

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Intended for IV administration only.

B Braun Ceftrifin and calcium-containing solutions, including continuous calcium-containing infusions eg, parenteral nutrition, should not be mixed or co-administered to any patient irrespective of age, even via different infusion lines at different sites.

Treatment of Skin and Skin Structure Infections: Recommended Total Daily Dose: 50-75 mg/kg given once a day (or in equally divided doses twice a day). The total daily dose should not exceed 2 g.

Treatment of Serious Miscellaneous Infections Other than Meningitis: Recommended Total Daily Dose: 50-75 mg/kg, given in divided doses every 12 hrs. The total daily dose should not exceed 2 g.

Treatment of Meningitis: Recommended Initial Therapeutic Dose: 100 mg/kg (not to exceed 4 g). Thereafter, a total daily dose of 100 mg/kg/day (not to exceed 4 g daily) is recommended. The daily dose may be administered once a day (or in equally divided doses every 12 hrs). The usual duration of therapy is 7-14 days.

Adults: Usual Daily Dose: 1-2 g given once a day (or in equally divided doses twice a day) depending on the type and severity of infection. The total daily dose should not exceed 4 g.

If Chlamydia trachomatis is a suspected pathogen, appropriate antichlamydial coverage should be added, because Ceftrifin sodium has no activity against this organism.

For preoperative use (surgical prophylaxis), a single dose of 1 g administered IV ½-2 hrs before surgery is recommended.

Generally, B Braun Ceftrifin therapy should be continued for at least 2 days after the signs and symptoms of infection have disappeared. The usual duration of therapy is 4-14 days; in complicated infections, longer therapy may be required.

When treating infections caused by Streptococcus pyogenes, therapy should be continued for at least 10 days.

Children: B Braun Ceftrifin in the Duplex container is designed to deliver a 1 or 2 g dose of Ceftrifin. To prevent unintentional overdose, B Braun Ceftrifin should not be used in pediatric patients who require less than the full adult dose of Ceftrifin.

Neonates: Hyperbilirubinemic neonates, especially prematures, should not be treated with B Braun Ceftrifin.

Hepatic and Renal Impairment: No dosage adjustment is necessary for patients with impairment of renal or hepatic function; however, blood levels should be monitored in patients with severe renal impairment (eg, dialysis patients) and in patients with both renal and hepatic dysfunctions.

Administration: Directions for Use: B Braun Ceftrifin should be administered IV by infusion over a period of 30 min.

Vancomycin, amsacrine, aminoglycosides and fluconazole are physically incompatible with Ceftrifin in admixtures. When any of these drugs are to be administered concomitantly with Ceftrifin by intermittent IV infusion, it is recommended that they be given sequentially, with thorough flushing of the IV lines (with one of the compatible fluids) between the administrations.

B Braun Ceftrifin should not be physically mixed with or piggybacked into solutions containing other antimicrobial drugs due to possible incompatibility.

After the indicated stability time periods, unused portions of solutions should be discarded.

Ceftrifin interactions

See also:
What other drugs will affect Ceftrifin?

No impairment of renal function after simultaneous administration of Ceftrifin with diuretics.

No interference with the action or increase in nephrotoxicity of aminoglycosides during simultaneous administration with Ceftrifin. The Ceftrifin molecule does not contain the N-methylthio-tetrazole substituent which has been associated with a disulfiram-like effect when alcohol is taken during therapy with certain cephalosporins.

In vitro, chloramphenicol has been shown to be antagonistic with respect to Ceftrifin and other cephalosporins.

Caution is advised if concurrent administration of Ceftrifin with chloramphenicol is proposed.

In patients treated with Ceftrifin, the Coombs' test may rarely become false-positive. Ceftrifin eg, other antibiotics, may result in false-positive test for galactosemia. Likewise, non-enzymatic methods for glucose determination in urine may give false-positive results. For this reason, urine glucose determination during therapy with Ceftrifin should be done enzymatically.

Ceftrifin may adversely affect the efficacy of oral hormonal contraceptives. Consequently, it is advisable to use supplementary (nonhormonal) contraceptive measures during treatment and in the month following treatment.

Incompatibilities: Solutions containing Ceftrifin should not be mixed with or added to solutions containing other agents. In particular, Ceftrifin is not compatible with calcium-containing solutions eg, Hartmann's solution and Ringer's solution. Ceftrifin is not compatible with amsacrine, vancomycin, fluconazole, aminoglycosides and labetalol.

Ceftrifin side effects

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What are the possible side effects of Ceftrifin?

Post-Marketing: During the use of Ceftrifin, the following side effects, which were reversible either spontaneously or after withdrawal of the drug, have been observed: Systemic Side Effects: Gastrointestinal complaints (about 2% of the cases): loose stools or diarrhea, nausea, vomiting, stomatitis and glossitis.

Hematological changes (about 2%): eosinophilia, leukopenia, granulocytopenia, hemolytic anemia, thrombocytopenia. Isolated cases of agranulocytosis (<500/mm3) have been reported, most of them after 10 days of treatment and following total doses of 20 g or more.

Skin reactions (about 1%): exanthema, allergic dermatitis, pruritus, urticaria, edema. Isolated cases of severe cutaneous adverse reactions (erythema multiforme, Stevens Johnson syndrome or Lyell's Syndrome/toxic epidermal necrolysis) have been reported.

Other, Rare Side Effects: Headache and dizziness, symptomatic precipitation of Ceftrifin calcium salt in the gallbladder, increase in liver enzymes, oliguria, increase in serum creatinine, genital mycosis, fever, shivering and anaphylactic or anaphylactoid reactions.

Interaction with Calcium: Two in vitro studies, one using adult plasma and the other neonatal plasma from umbilical cord blood have been carried out to assess interaction of Ceftrifin and calcium. Ceftrifin concentrations up to 1 mM (in excess of concentrations achieved in vivo following administration of 2 grams Ceftrifin infused over 30 minutes) were used in combination with calcium concentrations up to 12 mM (48 mg/dL). Recovery of Ceftrifin from plasma was reduced with calcium concentrations of 6 mM (24 mg/dL) or higher in adult plasma or 4 mM (16 mg/dL) or higher in neonatal plasma. This may be reflective of Ceftrifin-calcium precipitation.

A small number of cases of fatal outcomes in which a crystalline material was observed in the lungs and kidneys at autopsy have been reported in neonates receiving Ceftrifin and calcium containing fluids. In some of these cases, the same intravenous infusion line was used for both Ceftrifin and calcium-containing fluids and in some a precipitate was observed in the intravenous infusion line. At least one fatality has been reported in a neonate in whom Ceftrifin and calcium-containing fluids were administered at different autopsy in this neonate. There have been no similar reports in patients other than neonates.

Pseudomembranous enterocolitis and coagulation disorders have been reported as very rare side effects.

Very rare cases of renal precipitation have been reported, mostly in children older than 3 years and who have been treated with either high daily doses (e.g. ≥80 mg/kg/day) or total doses exceeding 10 grams and presenting other risk factors (e.g. fluid restrictions, confinement to bed, etc.). This event may be symptomatic or asymptomatic, may lead to renal insufficiency, and is reversible upon discontinuation of Ceftrifin.

Local Side Effects: In rare cases, phlebitis reactions occurred after i.v. administration. These may be minimized by slow (2-4 minutes) injection.

Intramuscular injection without lidocaine solution is painful.

Laboratory Abnormalities: Influence on Diagnostic Tests: In patients treated with Ceftrifin the Coombs' test may rarely become false-positive.

Ceftrifin, like other antibiotics, may result in false-positive tests for galactosemia.

Likewise, nonenzymatic methods for the glucose determination in urine may give false positive results. For this reason, urine-glucose determination during therapy with Ceftrifin should be done enzymatically.

Ceftrifin contraindications

See also:
What is the most important information I should know about Ceftrifin?

Hypersensitivity

Ceftrifin is contraindicated in patients with known hypersensitivity to Ceftrifin, any of its excipients or to any other cephalosporin. Patients with previous hypersensitivity reactions to penicillin and other beta lactam antibacterial agents may be at greater risk of hypersensitivity to Ceftrifin.

Neonates

Premature Neonates

Ceftrifin is contraindicated in premature neonates up to a postmenstrual age of 41 weeks (gestational age + chronological age).

Hyperbilirubinemic Neonates

Hyperbilirubinemic neonates should not be treated with Ceftrifin. Ceftrifin can displace bilirubin from its binding to serum albumin, leading to a risk of bilirubin encephalopathy in these patients.

Neonates Requiring Calcium Containing IV Solutions

Ceftrifin is contraindicated in neonates ( ≤ 28 days) if they require (or are expected to require) treatment with calcium-containing IV solutions, including continuous calcium-containing infusions such as parenteral nutrition because of the risk of precipitation of Ceftrifin-calcium.

Cases of fatal outcomes in which a crystalline material was observed in the lungs and kidneys at autopsy have been reported in neonates receiving Ceftrifin and calcium-containing fluids.

In some of these cases, the same intravenous infusion line was used for both Ceftrifin and calcium-containing fluids and in some a precipitate was observed in the intravenous infusion line. There have been no similar reports in patients other than neonates.

Lidocaine

Intravenous administration of Ceftrifin solutions containing lidocaine is contraindicated. When lidocaine solution is used as a solvent with Ceftrifin for intramuscular injection, exclude all contraindications to lidocaine. Refer to the prescribing information of lidocaine.



Active ingredient matches for Ceftrifin:

Ceftriaxone in Russian Federation.


Unit description / dosage (Manufacturer)Price, USD
Injectable; Injection; Ceftriaxone 1 g

List of Ceftrifin substitutes (brand and generic names):

CEFTRIL Injection / 1gm / 1 vial units (Tablets (India) Limited)$ 0.84
Ceftril 1g VIAL / 1 (Tablets (India) Limited)$ 0.84
1 g x 1's (Tablets (India) Limited)$ 0.84
Ceftril 1000 mg Injection (Tablets (India) Limited)$ 0.84
CEFTRIL 1GM INJECTION 1 vial / 1 injection each (Tablets (India) Limited)$ 0.95
CEFTRIL 250MG INJECTION 1 vial / 1 injection each (Tablets (India) Limited)$ 0.15
Ceftril 1g VIAL / 1 (Tablets (India) Limited)$ 0.84
Ceftril 1gm Injection (Tablets (India) Limited)$ 0.95
Ceftril 250mg Injection (Tablets (India) Limited)$ 0.15
Injectable; Injection; Ceftriaxone Sodium 500 mg (Lemery)
Injectable; Injection; Ceftriaxone Sodium 1 g (Lemery)
Ceftrimo-S 1000+500 Injection (Klintoz Pharmaceuticals Pvt Ltd)$ 1.57
Ceftrin 1 g x 1 Bottle (Jarson Pharmaceuticals)
Ceftrin 1000 mg Injection (Jarson Pharmaceuticals)$ 0.90
Ceftrion 1 gm Powder (Redson Pharmaceuticals)$ 1.04
Ceftrione 1 g x 1 Bottle in 1 tube dung mobi 10 mL
Ceftriphin 1 g x 1's (General Drugs House)
Ceftriphin inj 1 g 1's (General Drugs House)
1 g x 10's (Alcare (Akums Drugs Pharmaceuticals Ltd.))$ 1.14
250 mg x 10's (Alcare (Akums Drugs Pharmaceuticals Ltd.))$ 0.54
500 mg x 10's (Alcare (Akums Drugs Pharmaceuticals Ltd.))$ 0.76
Ceftrisone 1g INJ / 10 (Alcare (Akums Drugs Pharmaceuticals Ltd.))$ 1.14
Ceftrisone 250mg INJ / 10 (Alcare (Akums Drugs Pharmaceuticals Ltd.))$ 0.54
Ceftrisone 500mg INJ / 10 (Alcare (Akums Drugs Pharmaceuticals Ltd.))$ 0.76
Ceftrisone 1000 mg Injection (Alcare (Akums Drugs Pharmaceuticals Ltd.))$ 0.12
Ceftrisone 250 mg Injection (Alcare (Akums Drugs Pharmaceuticals Ltd.))$ 0.06
Ceftrisone 500 mg Injection (Alcare (Akums Drugs Pharmaceuticals Ltd.))$ 0.07
CEFTRISONE 1000MG INJECTION 1 vial / 5 ML injection each (Alcare (Akums Drugs Pharmaceuticals Ltd.))$ 0.26
CEFTRISONE 250MG INJECTION 1 vial / 1 injection each (Alcare (Akums Drugs Pharmaceuticals Ltd.))$ 0.18
CEFTRISONE 500MG INJECTION 1 vial / 1 injection each (Alcare (Akums Drugs Pharmaceuticals Ltd.))$ 0.19
Ceftrisone 1g INJ / 10 (Alcare (Akums Drugs Pharmaceuticals Ltd.))$ 1.14
Ceftrisone 250mg INJ / 10 (Alcare (Akums Drugs Pharmaceuticals Ltd.))$ 0.54
Ceftrisone 500mg INJ / 10 (Alcare (Akums Drugs Pharmaceuticals Ltd.))$ 0.76
Ceftrisone 1000mg Injection (Alcare (Akums Drugs Pharmaceuticals Ltd.))$ 0.05

References

  1. DailyMed. "CEFTRIAXONE SODIUM: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
  2. PubChem. "ceftriaxone". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
  3. DrugBank. "ceftriaxone". http://www.drugbank.ca/drugs/DB01212 (accessed September 17, 2018).

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