The possibility of using Solcoseryl ointment for cats. Application of solcoseryl to a cat

30.03.2020

Ceftriaxone is a third-generation cephalosporin antibiotic with a broad spectrum of action. It inhibits the formation of cell membranes bacterial cells... Ceftriaxone crosses the blood-brain barrier, the placenta, and partially passes into milk.

Ceftriaxone treatment of infectious diseases

Ceftriaxone is prescribed for (it must be remembered that for diseases caused by viruses, antibiotics are useless) of the respiratory tract (bronchopneumonia), ENT organs (sinusitis), urinary system (pyelonephritis, paranephritis), genital organs (adnexitis, gonorrhea), skin (erysipelas) ), organs abdominal (peritonitis), sepsis, etc.

How to dilute ceftriaxone for injection

Ceftriaxone intramuscularly - how to dilute

Dilution of ceftriaxone for intramuscular administration is carried out with 1% lidocaine solution in a volume of 2-3 ml. or 2% lidocaine solution and water for injection in a 1: 1 ratio. The powder of the drug dissolves quickly without forming a precipitate or turbidity. If flakes, crumbs or cloudiness occur, do not use the solution. The adult dosage is on average 1-2 g per day. The introduction of the drug is single (some experts do not recommend injecting more than 1 g of the drug into one gluteus muscle). Children over 12 years old receive an adult dosage, and for younger ones, the dose should be calculated based on the mass: 20-80 mg per 1 kg of the child's weight. The dosage is determined by the doctor when examining the child and assessing the severity of the underlying disease and the risk of complications.

IV ceftriaxone - how to dilute

For intravenous administration, lidocaine is not used, since it affects the work of the heart. Suitable 0.9% saline sodium chloride solution or water for injection. The drug should be injected extremely slowly, the best option is drip.

Important to remember:

- The solution should be prepared immediately before administration.
- The remaining solution is not used the next day, as it loses sterility.
- The drug should be injected deep into the muscle, therefore, 2-3 ml syringes for adults. will not fit. It is acceptable to use only 5 ml syringes.
- Lidocaine is not used to dilute the drug when administered intravenously.
- Intravenous administration should be carried out extremely slowly, the best option is drip.
- Do not use other antibiotics and calcium-containing drugs together with ceftriaxone (especially, do not dilute the powder with solutions containing calcium).
- As with the use of other antibiotics, you should pay attention to the intestinal microflora: taking linex, lactobacterin or systematic intake of biokefir is suitable.
- Seals at the injection site may form due to the introduction of cold solutions. Local heat (such as a heating pad) will increase blood flow to the muscle and enhance drug absorption.
- The appearance of intense pain at the injection site, a sharp increase in temperature, the appearance of softening in the center of the seal is a signal to see a doctor.

In the article, we will talk about diluting the antibiotic Ceftriaxone with 1% and 2% Lidocaine solution or water for injection for adults and children in order to get the initial dosage of the ready-made solution of the drug 1000 mg, 500 mg or 250 mg.

We will also analyze what is better to use for diluting the antibiotic - Lidocaine, Novocaine or Water for Injection, and what better helps to relieve pain during the injection of a ready-made solution of Ceftriaxone.

These questions are the most common, so now there will be a link to this article so as not to be repeated. Everything will be with examples of use.

In all instructions for Ceftriaxone (including for drugs under a different name, but with the same composition), exactly 1% Lidocaine is recommended as a solvent.

1% Lidocaine is already contained as a solvent in the packages of drugs such as Rosin, Rocefin and others (the active ingredient is Ceftriaxone).

Benefits of Solvent Ceftriaxone in Pack:

no need to separately buy a solvent (figure out which one);
the required dose of the solvent has already been measured in the ampoule of the solvent, which helps to prevent mistakes when typing the required amount into the syringe (no need to figure out how much solvent to take);
an ampoule with a solvent contains a ready-made solution of 1% lidocaine - there is no need to dilute 2% lidocaine to 1% (in pharmacies it can be difficult to find exactly 1%, you have to dilute it with additional water for injection).

Disadvantages of Ceftriaxone with solvent in the package:

an antibiotic together with a solvent is more expensive in price (choose what is more important to you - convenience or cost).

How to breed and how to inject Ceftriaxone

For intramuscular injection, 500 mg (0.5 g) of the drug should be dissolved in 2 ml (1 ampoule) of a 1% solution of Lidocaine (or per 1000 mg (1 g) of the drug - 3.5 ml of Lidocaine solution (usually 4 ml, since this is 2 ampoules of Lidocaine, 2 ml each)). It is not recommended to inject more than 1 g of solution into one gluteus muscle.

The dosage of 250 mg (0.25 g) is diluted in the same way as 500 mg (ampoules of 250 mg did not exist at the time of this writing). That is, 500 mg (0.5 g) of the drug should be dissolved in 2 ml (1 ampoule) of a 1% solution of Lidocaine, and then drawn into two different syringes, half of the finished solution.

Thus, we summarize:

1.250 mg (0.25 g) of the finished solution is obtained as follows:

500 mg (0.5 g) of the drug should be dissolved in 2 ml (1 ampoule) of a 1% solution of Lidocaine and the resulting solution should be drawn into two different syringes (half of the finished solution).

2.500 mg (0.5 g) of the finished solution is obtained as follows:

500 mg (0.5 g) of the drug should be dissolved in 2 ml (1 ampoule) of 1% lidocaine solution and draw up the resulting solution in 1 syringe.

3.1000 mg (1 g) of the finished solution is obtained as follows:

1000 mg (1 g) of the drug should be dissolved in 4 ml (2 ampoules) of a 1% solution of Lidocaine and draw the resulting solution into 1 syringe.

How to dilute Ceftriaxone with 2% lidocaine solution

Below is a plate with diagrams for diluting the antibiotic Ceftriaxone with 2% Lidocaine solution (2% solution is found in the pharmacy more often than 1% solution about the dilution method that we have already discussed above):

Abbreviations in the table: CEF - Ceftriaxone, R-l - solvent, In injection - water for injection. Further examples and explanations.

The child was prescribed a course of Ceftriaxone injections twice a day, 500 mg (0.5 g) for 5 days. How many vials of ceftriaxone, diluent ampoules and syringes are needed for the entire course of treatment?

If you bought Ceftriaxone 500 mg (0.5 g) (the most convenient option) and Lidocaine 2% at the pharmacy, you will need:

10 vials of ceftriaxone;
10 ampoules of lidocaine 2%;
10 ampoules of water for injection;
20 syringes, 2 ml each (2 syringes for each injection - we add the solvent with one, we collect and inject with the second).

If you bought Ceftriaxone 1000 mg (1.0 g) at the pharmacy (you did not find ceftriaxone 0.5 g), and Lidocaine 2%, you will need:

5 vials of Ceftriaxone;
5 ampoules of Lidocaine 2%
5 ampoules of water for injection
5 syringes 5 ml each and 10 syringes 2 ml each (3 syringes for the preparation of 2 injections - add the solvent with one, with the second and third we collect the required volume, with the second collet immediately, put the third in the refrigerator and with the collet after 12 hours).

The method is acceptable provided that the solution is prepared immediately for 2 injections and the syringe with the solution is stored in the refrigerator (freshly prepared solutions of ceftriaxone are physically and chemically stable for 6 hours at room temperature and for 24 hours when stored in a refrigerator at a temperature of 2 ° to 8 ° C ).

Disadvantages of this method: injection of an antibiotic after storage in the refrigerator may be more painful; during storage, the solution may change color, which indicates its instability.

The same dosage of Ceftriaxone 1000 mg and Lidocaine 2%, although the scheme is more expensive, but less painful and safer:

10 vials of ceftriaxone;
10 ampoules of lidocaine 2%;
10 ampoules of water for injection;
10 syringes 5 ml each and 10 syringes 2 ml each (2 syringes for each injection - add the solvent with one (5 ml), collect and inject the second (2 ml)). Half of the resulting solution is drawn into the syringe, the rest is discarded.

Disadvantage: Treatment is more expensive, but freshly prepared solutions are more effective and less painful.

Now popular questions and answers to them.

Why use Lidocaine, Novocaine to dilute Ceftriaxone and why you can't use water for injection?

To dilute Ceftriaxone to the desired concentrations, you can also use water for injection, there are no restrictions here, but you need to understand that intramuscular injections of an antibiotic are very painful and if this is done on water (as they usually do in hospitals), then it will hurt as much as when administered drug, and some time after. So it is preferable to use the anesthetic solution as a dilution agent, and use water for injection only as an auxiliary solution when diluted with Lidocaine 2%.

There is also such a moment that it is not possible to use Lidocaine and Novocaine due to the development of allergic reactions to these solutions. Then the option with the use of water for injection for dilution remains the only possible one. Here you will have to endure pain, since there is a real chance of dying from anaphylactic shock, Quincke's edema, or getting a strong allergic reaction (the same urticaria).

Also, Lidocaine cannot be used for intravenous administration of an antibiotic, only STRICTLY intramuscularly. For intravenous use, the antibiotic must be diluted with water for injection.

What is better to use Novocaine or Lidocaine to dilute the antibiotic?

Novocaine should not be used to dilute Ceftriaxone. This is due to the fact that Novocaine reduces the activity of the antibiotic and, in addition, increases the risk of a fatal complication in the patient - anaphylactic shock.

In addition, according to the observations of the patients themselves, the following can be noted:

pain with the introduction of ceftriaxone is better relieved by lidocaine than Novocaine;
pain during administration may increase after the introduction of not freshly prepared solutions of Ceftriaxone with Novocaine (according to the instructions for the drug, the prepared solution of Ceftriaxone is stable for 6 hours - some patients practice the preparation of several doses of Ceftriaxone + Novocaine solution at once to save the antibiotic and solvent (for example, 250 mg solutions of ceftriaxone from powder 500 mg), otherwise the residue would have to be thrown away, and for the next injection use a solution or powder from new ampoules).

Can I mix different antibiotics in one syringe, including Ceftriaxone?

In no case should the solution of ceftriaxone be mixed with solutions of other antibiotics, because it may crystallize or increase the patient's risk of developing allergic reactions.

How to reduce pain with ceftriaxone administration?

It is logical from the above - you need to dilute the drug with Lidocaine. In addition, the skill of introducing the finished drug plays an important role (you need to enter slowly, then pain will be small).

Can I prescribe an antibiotic myself without consulting a doctor?

If you are guided by the main principle of medicine - Do no harm, then the answer is obvious - NO!

Antibiotics are medicines that cannot be dosed and prescribed by yourself, without consulting a specialist. Since choosing an antibiotic on the advice of friends or on the Internet, we thereby narrow the field of activity for doctors who can treat the consequences or complications of your disease. That is, the antibiotic did not work (it was injected or diluted incorrectly, it was taken incorrectly), but it was good, and since the bacteria had already become accustomed to it as a result of the wrong treatment regimen, it would be necessary to prescribe a more expensive backup antibiotic, which, after an incorrect previous treatment, will also be unknown. whether. So the situation is clear - you need to go to the doctor for a prescription and appointment.

Also, allergy sufferers (ideally, again, all patients who take this drug for the first time) are also shown the appointment of scarification tests to determine allergic reaction on prescribed antibiotics.

Also, ideally, it is necessary to inoculate biological fluids and human tissues with the determination of the sensitivity of the inoculated bacteria to antibiotics, so that the prescription of a particular drug is justified.

I would like to believe that after the appearance of this article in the Directory of questions on the methods and schemes for diluting the antibiotic Ceftriaxone, there will be fewer questions, since I have disassembled the main points and schemes here, it remains only to read carefully.

Ceftriaxone: how to dilute with lidocaine and water for injection

The drug Ceftriaxone is a broad-spectrum antibiotic that belongs to the type of cephalosporic drugs. This drug is intended to fight infectious diseases in the body.

The task of the drug is to destroy pathogenic microorganisms. The medicine Ceftriaxone is very painful both intramuscularly and intravenously. To solve this problem, it was decided to dilute the Ceftriaxone powder with anesthetics that significantly reduce pain.

What diseases is Ceftriaxone used for?

Ceftriaxone: what helps? Diseases in the body of a child and the body of an adult are caused by microorganisms: viruses, bacteria, fungi. The bacteria that cause infections are sensitive enough to the antibiotic Ceftriaxone. They use this remedy for the following diseases:

otitis media of ENT organs;
inflammation of the nasopharynx (sinusitis, sinusitis);
infectious sore throat, pharyngitis, tonsillitis;
ARI (bronchitis, tracheitis);
infectious pneumonia;
diseases of pyelonephritis;
prostatitis in the male body;
bacterial cystitis;
acute and latent form of urethritis;
endometritis disease;
gynecological diseases;
gonorrhea, syphilis, chancre;
diseases of the stomach and intestines;
diseases caused by E. coli;
salmonellosis;
purulent meningitis;
purulent sepsis;
purulent diseases of the skin.

The therapeutic effect of using this drug shows a positive result - already from the second or third day of taking the drug, positive dynamics are observed.

Why dilute Ceftriaxone

A large mass of various antibacterial drugs used for injection are produced in vials with lyophilized powder. Before use, this powder must be dissolved in saline or in anesthetics (lidocaine, novocaine).

Ceftriaxone is available only in powder form; this agent is not available in the form of ready-made solutions and suspensions.

But when using an antibiotic of this type, it is necessary to understand exactly how the patient reacts to this solution, what exactly should be used to dilute the medicine in powder, water, saline or lidocaine. It is necessary to make sure that the patient does not have an allergy to anesthetics, which can harm the body of the sick person.

It is very important to know exactly where the injection should be given, solutions of Ceftriaxone with lidocaine cannot be used if the injection must be given intravenously.

Dilution of Ceftriaxone with Lidocaine

How to dilute ceftriaxone with lidocaine? Ceftriaxone diluted with Lidocaine may cause an allergic reaction in the body. To avoid this, before giving the injection, you need to conduct a reaction test, which can show how a person reacts to substances. It is necessary to make two small scratches on the skin on the inner side of the hand and apply a little Ceftriaxone and Lidocaine on them, each preparation in a separate scratch. If the skin at the site of scratching turns red after 5 to 10 minutes, then you cannot take the drug. If the skin in these places remains unchanged, then there is no allergy to drugs. Ceftriaxone how to dilute with lidocaine and water for injection?

Ceftriaxone does not mix with any antibacterial drugs - this can lead to an allergic reaction;
for the manufacture of a solution of the antibiotic Ceftriaxone - Novocaine is not used instead of the drug Lidocaine is not worth it: the anesthetic reduces the therapeutic effect of the antibiotic and can lead the patient to a state of anaphylactic shock;
ceftriaxone diluted in anesthetic - do not store for more than 6 hours;
for intravenous use an antibiotic drug, it is forbidden to dilute Ceftriaxone with Lidocaine;
make an injection into the buttock and inject the drug slowly enough.

In order to make a suspension for injections of the drug Ceftriaxone using the substance Lidocaine, it is necessary to carry out the following manipulations:

on the antibiotic bottle, it is necessary to bend the aluminum cap and wipe it with cotton wool and alcohol;
3.5 ml of a solution of Lidocaine 1% is injected into a bottle of 1.0 g of Ceftriaxone;
insert the syringe with the needle into the cap and squeeze out the lidocaine;
shake the bottle with the drug until Ceftriaxone is completely dissolved in the anesthetic.

If at the moment the pharmacy does not have Lidocaine 1%, then Lidocaine 2% can also be used, and it is also necessary to purchase a specialized liquid for making injections (saline) along with this anesthetic:

Mix 2 ml of Lidocaine 2% solution with 2 ml of water for making injections, shake the syringe so that the liquid mixes together as much as possible;
after that, the same manipulations are performed as with the use of Lidocaine 1%.

Dilution of the antibiotic ceftriaxone for intravenous use

In order to dilute Ceftriaxone for intravenous injections, sodium chloride solution is used. The intravenous procedure should be carried out very carefully and the antibiotic should be administered as slowly as possible.

If a single dosage, according to the treatment regimen prescribed by the doctor, exceeds 1 g of Ceftriaxone, then there is a need, instead of an intravenous injection, to administer the medicine by the drip method. The procedure using a dropper should last at least 30 minutes and use 100 ml of liquid sodium chloride to prepare a drop solution.

The prepared solution for intravenous use in the form of a dropper or injection must be used immediately after preparation. A freshly prepared medicine gives much faster positive results in treatment.

The use of Ceftriaxone when carrying a child and breastfeeding a child

The drug Ceftriaxone during pregnancy is prescribed in an extreme situation, if the benefits of taking medication will be much higher than the threat of side pathologies for the developing fetus.

When taking this drug, you need a special doctor's control over the state of the body of the expectant mother and the state of the intrauterine fetus.

If there is an urgent need to take an antibiotic during lactation, then you need to refuse breastfeeding.

Use of the drug Ceftriaxone for a child's body

For newly born children, children who are breastfeeding and children under 12 years of age, according to the instructions for use, use the following regimen for treatment:

children under 14 days of age from birth mg of antibiotic per kilogram of baby weight. It is strictly forbidden to increase the dose more than 50 mg per day;
for infants from one month after birth until the child reaches 12 years of age, mg of antibiotic per kilogram of the baby's weight. If it is necessary to exceed the daily dose of the drug, in this case, the drip method of drug administration is used.

For children over 12 years old, the drug is prescribed as adults.

Contraindications to the use of this medication

According to the instructions for use, like any drug, Ceftriaxone has a contraindication for various diseases organism:

intolerance to the components;
an allergic reaction to substances in the composition of the product;
allergic intolerance to cephalosporins;
increased levels of bilirubin in the blood;
myocardial infarction and heart failure;
epilepsy;
nervous irritability;
patients undergoing hemodialysis;
chronic and acute liver diseases;
cirrhosis of the liver;
diseases of the kidneys and adrenal glands;
alcoholism;
carrying a child (use in the first trimester is especially dangerous);
breastfeeding the baby;

Complications from taking Ceftriaxone

Complications after taking the drug Ceftriaxone usually develop with an overdose or improper use.

The action of the drug is aimed at suppressing microbes and, together with harmful infections, beneficial microbes in the microflora of the stomach and intestines can die, and against the background of this indicator, dysbacteriosis develops in the body with pronounced symptoms:

abdominal pain;
frequent and loose stools;
nausea and possibly vomiting.

If abdominal pain appears, this is the first sign of dysbiosis. Taking probiotics in this period is mandatory.

The consequences of dysbiosis can be fungal infections, and with a disturbed microflora, these infections have the ability to multiply quickly enough.

Symptoms of a fungal infection in the body:

thrush in children of the age of breastfeeding;
vaginitis or thrush in girls, which causes pain when urinating;
itching of the genitals with redness of the vulva;

Before taking this drug, it is imperative that you consult with your doctor.

Side effects of using Ceftriaxone

After using the antibiotic Ceftriaxone, a number of side effects occur:

constant nausea, after eating - vomiting;
painful diarrhea, constipation;
acute form of dysbiosis;
stomatitis with bright painful sensations;
overexcitation;
anxiety;
insomnia;
sharp pain in the head;
morning strong head spin;
acute conjunctivitis;
anaphylactic shock and possibly coma;
itching in the genitals;
candidiasis of the vaginal mucosa.

Before you start taking this medication, it is imperative to consult with your doctor.

The reaction to the drug from the side of allergies is manifested in angioedema, rash on the skin, anaphylactic shock. Dyspeptic indicators are disturbances in the state of appetite, severe nausea, belching, vomiting after taking or while eating.

Only compliance with all the prescriptions of the attending doctor will guarantee a positive effect on the body of the antibiotic Ceftriaxone.

Antibiotic Ceftriaxone: appointment, use, how to properly dilute at home

If we compare the prescription of doctors, then the drug Ceftriaxone is the leader among antibiotics for parenteral use. Due to its versatility, it is very often prescribed for the treatment of various inflammatory processes outpatient and inpatient settings.

About the drug Ceftriaxone is known not only to medical workers, but also to ordinary patients who often suffer from respiratory diseases. Ceftriaxone belongs to the group of 3-generation cephalosporins and is a broad-spectrum antibiotic. Oppressing transpeptidase stops the biosynthesis of mucopeptide of the bacterial cell wall.

The action of the drug extends to many microorganisms: some gram-positive and gram-negative aerobes, anaerobic microorganisms.

Prescribing Ceftriaxone

The active appointment of Ceftriaxone is observed in the sheets of the following departments: therapy, surgery, urology, pediatrics and even venereology. When is Ceftriaxone used? The most common conditions for which Ceftriaxone is used are:

Inflammatory processes of ENT organs;
Frequent diseases of the respiratory system (acute and chronic bronchitis, tracheitis, pneumonia);
Skin and soft tissue infections;
Inflammatory diseases of the genitourinary system of adults and children (acute and chronic cystitis, pyelonephritis, glomerulonephritis, prostatitis, uncomplicated gonorrhea, gynecological diseases);
Infectious processes of the digestive tract (peritonitis, postoperative conditions on the digestive system);
With osteomyelitis (infection of the bones);
With the carriage of salmonella and diseases resulting from its vital activity;
Syphilis (soft chancre) treatment;
With infectious neurological diseases (meningitis, Lyme disease);
For the prevention of the development of infectious processes after various surgical procedures.

Why dilute Ceftriaxone

Since Ceftriaxone is available in powder form, it must be dissolved for administration. The undissolved drug is used only in the form of a powder for bedsores, ulcerative skin lesions and long non-healing wounds. Why dilute Ceftriaxone in patients? This only happens in cases of home treatment. Sometimes the sick refuse medical care and do intramuscular injections on their own with the help of relatives or close people.

To dilute the drug at home, you should first of all have aseptic conditions. You should also stock up on antiseptics and ask your doctor how to dilute Ceftriaxone yourself. Intramuscular administration of antibiotics is a rather painful procedure, therefore, 1% lidocaine solution or 50% novocaine is used to dilute them. These drugs significantly reduce the painfulness of the injection, but sometimes cause complex allergic reactions.

Therefore, before the introduction, a test should be made for an allergic reaction to both an antibiotic and an anesthetic. To do this, use an insulin syringe to inject the minimum dose of the drug diluted with water for injection on the wrist. If no changes appear at the injection site after 20 minutes, the drug can be administered.

Dilution of ceftriaxone for intramuscular administration

Provided that the patient does not have allergic reactions to the antibiotic and to the solvent, the drug can be administered. If lidocaine was chosen to reduce pain, then 2 ml of a 2% solution should be drawn into a syringe (as a rule, this is a whole ampoule) and 3 ml of water for injection should be added. This is done to dilute Ceftriaxone thoroughly, as lidocaine is a poor solvent and a fairly strong local anesthetic. Use scissors to open the metal cap on the bottle. Alcohol solution treat the rubber stopper before inserting the needle. Shake the bottle thoroughly until completely dissolved. Ready solution of Ceftriaxone for intramuscular use is drawn back into the syringe.

Dilution table of Ceftriaxone with lidocaine 2% for intramuscular injection

For intramuscular injection of Ceftriaxone solution, use a syringe with two needles, or 2 syringes. Before carrying out the manipulation, the needle should be replaced with a new one. After piercing the rubber, the old one has become significantly dull, and this can cause additional pain and bruising. For children under 1 year old, Ceftriaxone is diluted only with water for injection or sodium chloride solution.

Ceftriaxone is injected intramuscularly slowly and deeply. The antibiotic can only be injected into the upper outer quadrant (gluteus muscle). Seals may form at the injection site. For their prevention, you can make an iodine grid.

Dilution of ceftriaxone for intravenous use

Most often, when diluting Ceftriaxone for intravenous administration, 0.09 sodium chloride solution is used. If the dosage does not exceed 1 g, then the drug is injected slowly in a stream. In other cases, the solution is injected with a dropper over 30 minutes using 100 ml of sodium chloride solution.

Ceftriaxone is administered intravenously only in the office of a medical institution. If the patient insists on treatment at home, then the help of a qualified healthcare professional is required. Ceftriaxone IV solution should be used immediately after reconstitution. The drug administered intravenously enters the bloodstream much faster, therefore its effectiveness is much higher. In addition, patients experience less unpleasant painful sensations.

Contraindications and individual intolerance to Ceftriaxone

In most cases, Ceftriaxone is tolerated without adverse effects. In some cases, there are rare reactions. Almost always, allergic reactions can be avoided, because before starting antibiotic treatment, a sensitivity test is performed.

Hypersensitivity to antibiotics from the cephalosporin group (if the patient has had reactions to drugs of the penicillin group, then the likelihood of a cross-allergic reaction to Ceftriaxone increases).
Premature babies (before prescribing the drug, the pediatrician takes into account the need for such therapy, having previously calculated the gestational age and age after birth).
Elevated blood bilirubin levels in premature and newborn babies. This is due to the property of Ceftriaxone to displace the bilirubin molecule from the bond with blood plasma albumin. This condition can trigger the development of encephalopathy.
Treatment with ceftriaxone is prohibited in the first trimester of pregnancy, since it is during this period that there is the greatest risk of mutations.
Breastfeeding period - since the drug is infiltrated into breast milk... During this period, feeding should be postponed until the end of treatment.
Hepatic renal failure is a contraindication to treatment with Ceftriaxone. If, for medical reasons, the doctor is forced to prescribe this drug, you should monitor the indicators functional state kidney and liver.

If the patient is on hemodialysis, then the plasma concentration of Ceftriaxone should be measured regularly. Ceftriaxone intolerance may occur due to the characteristics of the body. Most often, the cause is genetic characteristics or long-term antibiotic therapy in history.

Have you used Ceftriaxone or treated with other drugs?

Instructions for use Ceftriaxone, how to dilute for injections

How to dilute ceftriaxone with lidocaine and water for injection? It is an antibacterial drug that helps to resist infection. Since injections of a drug by the body are perceived rather painfully, it is necessary to use an anesthetic. It is necessary to adhere to the established proportions and avoid long-term storage of the prepared solution.

Purpose and features of using the drug

Due to the constant development of medicine, more and more new drugs are being produced that are able to cope much more effectively with pathological disorders. Among the drugs of the new generation, there are many antibiotics that have a wide spectrum of action and eliminate infectious ailments in the shortest possible period. One of these antibiotic agents is Ceftriaxone, which has pronounced bactericidal properties.

Instructions for use of this medicine says: with intramuscular administration of an antibiotic, there is a rather strong painful discomfort. To reduce discomfort, the drug is shown to be diluted with an anesthetic.

Ceftriaxone is a white crystalline powder that is sometimes yellowish in color.

The substance for intravenous or intramuscular administration is prescribed to patients with:

damage to the respiratory system of infectious etiology;
skin inflammation;
diseases of the urinary system;
venereal pathologies;
gynecological problems;
peritonitis.

As practice shows, thanks to injections, already on the second or third day, there are positive changes in the patient's condition.

It is also necessary to dilute a medicinal substance before use for the reason that it is produced in powder form, like many other medicines with antibacterial properties. The antibiotic has no other forms of release. Instructions for use indicate that for dilution, you should use a saline solution of sodium chloride or anesthetic drugs - Lidocaine, Novocaine.

It is important to remember that each patient will react differently to the antibiotic and the agents in which it should be dissolved. Injections should be done only after a special test has been performed to show whether the prepared solution is suitable for the patient or not.

What is the best way to dilute the drug?

It is necessary to consider in more detail the question of what means and why doctors recommend diluting the antibiotic.

As already mentioned, you can dissolve a medicinal substance:

distilled water;
sodium chloride;
Lidocaine;
Novocaine.

Ceftriaxone is only diluted with water for intravenous administration. In this case, there is no need for anesthetics. They will be needed only when intramuscular injections are prescribed to the patient, because this method of administration is accompanied by severe pain discomfort.

Before injecting Ceftriaxone, it is best to ask a specialist which solvent is best for treatment. Do not forget about the many nuances that may arise.

For example, if an antibiotic is prescribed for intramuscular (i / m) administration to a child, dilution of the anesthetic with water or sodium chloride is indicated. The ratio of the drug and distilled liquid or saline solution is 1: 1.

To obtain the desired drug concentration, dilution with water for injection is provided. But with intramuscular injections, the patient will have to endure pain both during the procedure and after it. It is better to take water to dilute 2% Lidocaine, since, according to the instructions, the Lidocaine used should be 1% concentration.

Water for injection will be the only option for those patients who have an allergic reaction to anesthetics.

Correct dosages

How to dilute Ceftriaxone before an upcoming injection? In some patients, administration of an antibiotic that is dissolved in lidocaine may elicit an unwanted immune response.

In order not to harm the patient, you should first check how the body reacts to the Ceftriaxone solution. To do this, two small scratches are made on the inside of the forearm. One of them is treated with a small amount of antibiotic, the other is treated with an anesthetic. You will need to wait about 5-10 minutes for the results. If the tested skin area has retained its natural color, then the injection is allowed.

The attached instructions for use for the antibiotic agent recommends dissolving Ceftriaxone 1% with Lidocaine.

To dilute Ceftriaxone 1 g, do the following:

a syringe with a capacity of 5 cubes is taken and 3.5 ml of Lidocaine solution is drawn;
on the bottle containing the powder, bend the aluminum cap;
the rubber stopper is processed with a cotton swab dipped in alcohol;
a needle is inserted into the cork and the solution is slowly introduced;
to dilute Ceftriaxone, the bottle must be shaken well.

When diluting a powdery substance, problems should not arise, since it dissolves quite easily. Doctors warn: if you dilute the medicine and turbidity or any third-party impurities appear, you should refrain from using the solution.

Unfortunately, it is not always possible to get 1% Lidocaine. Usually 2% anesthetic is sold in pharmacies. In such a case, to achieve best effect, it should be diluted with a small amount of water.

Before diluting 1 g (1000 mg) of an antibiotic drug with 2% lidocaine, you must:

Prepare one ampoule of anesthetic and distilled water, which will be mixed in one syringe.
First, you should take 2 ml of Lidocaine, and then the liquid in the same amount.
To obtain a solution, the contents of the syringe are vigorously shaken.
Now the required concentration of the anesthetic is injected into the bottle containing the powder.

As stated in the instructions, if you need to dilute Ceftriaxone in an amount of 0.5 g, you need to prepare 1 ml of Lidocaine and water.

For adult patients, it is allowed to use no more than two grams of a diluted substance per day, while a maximum of 1 g of medication can be injected into one buttock.

It is advisable that a qualified nurse dilute and inject the medicine into the vein. The procedure should be carried out carefully and slowly. If, according to the doctor's prescription, you need to enter a dose that exceeds 1 g, the injection is replaced with a dropper. To prepare the solution, you will need sodium chloride in an amount of 100 ml. The dropper is put on for at least half an hour.

The diluted mixture must be used immediately. If the solutions are injected immediately after preparation, the desired results can be obtained much faster.

Dosages for children, during pregnancy and lactation

Can Ceftriaxone be used in childhood and how to do it correctly? Ceftriaxone can be administered intramuscularly from birth.

The dosage of the medicine is set taking into account age category patients:

Babies up to 2 weeks of age are prescribed by the introduction of the drug per kilogram of weight.
Starting from the first month of life and up to 12 years, it is shown to take from 20 to 75 mg of the substance per 1 kg of body weight.

If you need to use a diluted drug in a dose that is more than the established norm, a dropper is used instead of an injection. Children from 12 years of age are prescribed the same dosages as adults.

Despite the accepted norms of the drug, when drawing up a treatment course, the dosage is selected on an individual basis. The specialist must take into account clinical manifestations ailment, its severity and characteristics of the child's body.

For women in position and lactating, treatment with diluted Ceftriaxone is not recommended. However, the injection can also be given to pregnant women if the benefits of the medication outweigh the possible harm to the fetus. During lactation, an injection solution is also prescribed only in extreme cases, while the baby is transferred to artificial mixtures.

Contraindications and possible complications

Ignoring them and non-compliance with dosages, especially when intravenous injections, may cause dangerous consequences in both the adult and the child.

Entering Ceftriaxone is prohibited when:

excessive sensitivity to the components of the solution;
high levels of bilirubin;
heart failure;
myocardial infarction;
epileptic disorders;
nervous excitability;
hemodialysis course;
liver lesions of an acute or chronic nature;
problems with the kidneys and adrenal glands;
alcohol addiction;
pregnancy (especially in the 1st trimester);
breastfeeding.

Intramuscular administration of an antibiotic, which was previously diluted with an analgesic agent, can result in a number of undesirable reactions:

constantly present nausea;
vomiting after eating;
acute manifestations of dysbiosis;
stomatitis with intense symptoms;
rashes;
angioneurotic edema;
excessive emotion;
anxiety;
sleep disorders;
sharp pains in the head;
dizziness upon waking up;
conjunctivitis in acute form;
anaphylactic shock;
itchy discomfort in the genitals;
candidiasis.

If the patient does not adhere to the prescribed dosages or begins to use a solution that has been stored longer than expected, the appearance of dysbiosis is not excluded. The drug has the ability to suppress the activity of microbes. With the illiterate use of drugs, along with pathogenic microorganisms, useful ones die.

Symptoms in the form of:

abdominal pain;
frequent diarrhea;
nausea and vomiting.

Due to dysbiosis, the development of a fungal infection is possible.

For antibiotic treatment to be effective, it is necessary to adhere to important conditions:

You should first read the instructions, which indicate how to dilute Ceftriaxone and in what proportions.
It is better to dilute the prescribed ceftriaxone with lidocaine. If you take Novocaine, the antibacterial agent will be less effective, while serious complications are not excluded, for example, anaphylactic shock.
It is forbidden to mix Ceftriaxone with other antibiotic drugs, otherwise you should expect intense allergic manifestations.
When diluted, the injection dose can be stored for no longer than 6 hours.
Lidocaine, considered the best anesthetic, is only used for intramuscular injection. To administer the powder intravenously, it is diluted in saline or sterile water.
The injection area is the upper gluteus maximus. The dissolved antibiotic is injected gradually so as not to provoke severe pain.
If an intramuscular injection has caused negative reactions, you should immediately inform your doctor about the incident.

Ceftriaxone is a broad-spectrum antibiotic from the third generation cephalosporin group. It has a bactericidal effect, that is, it kills pathogenic flora. It is used in the treatment of infections different systems bodies:

in pulmonology in the treatment of bronchopneumonia;
in general surgery for the treatment of erysipelas of the skin;
in dermatovenerology to combat gonorrhea;
in urology and nephrology with pyelonephritis.

Ceftriaxone should be diluted with novocaine according to certain rules.

Release form and solutions for diluting the antibiotic

Like most antibiotics, the active ingredient of the drug Ceftriaxone is supplied not in the form of a ready-made solution, but in the form of a slightly yellowish or crystalline powder. white... It fits in clear glass bottles under a rubberized stopper and aluminum cap. This is done for reasons of staying active. active substance - ceftriaxone. The powder is readily soluble in water (the dissolution time should be no more than 2 minutes according to the standard), very slightly - in ethanol. The resulting substance varies in color from light yellow to amber, depending on the shelf life, the type of solvent used and the concentration of the drug.

The drug is dispensed from pharmacies in bottles of 0.25, 0.5, 1 or 2 grams in the form of sterile sodium salt of Ceftriaxone. The most common dosage is 1 g. The instructions for medical use of the drug say that this drug can be administered exclusively parenterally: intravenously or intramuscularly. Getting into the body in one of these ways, the drug is completely absorbed, bioavailability is 100%. The powder is allowed to be diluted with water for injection or anesthetics (Lidocaine, Novocaine). These are common antibiotic dilution liquids. The choice of solution depends on the way the drug enters the body. If a doctor writes a prescription for ceftriaxone for intramuscular administration, then it is permissible to use any of these solutions. If the medication must be administered intravenously, then the only permitted liquid is water for injection. For this purpose, lidocaine and Novocaine are strictly prohibited.

Features of Ceftriaxone injections

The preparation procedure is simple. Knowing the precautions and important aspects in the technology of dilution and use of the antibiotic, you can correctly prepare the composition of the desired concentration.

The good news is that both ceftriaxone and its sterile diluent are easy to buy from your regular pharmacy with a doctor's prescription.

Almost all patients note that Ceftriaxone injections are extremely unpleasant and painful, especially when dissolved in water for injection. Moreover, negative sensations will accompany both the very process of drug administration and will persist for some time after manipulation. Therefore, it is much better to dilute the drug with painkillers to facilitate the tolerance of the injection.

One of the permitted solvents is a 0.5% Novocaine solution. You can also use 1 or 2% lidocaine solution. Doctors still differ on the best basis for the drug. It should be noted that, according to some scientific data, Novocaine can slightly reduce the severity of the action of Ceftriaxone, and increase the risk of anaphylactic shock in a patient. But still, it relieves pain when injected quite well in comparison with ordinary water for injection.

Before the introduction of the full dose of the drug, it is worth making a test for the tolerability of Ceftriaxone and the anesthetic used. To do this, you need to make a couple of small scratches on the skin of the inner part of the forearm and apply a few drops of Ceftriaxone and Novocaine to them separately. If a person has a high sensitivity to one or both of the components, then the skin at the site of application of the drugs will turn red in 5-10 minutes, edema and local itching may occur. If all is well and there is no allergic reaction to any of the drugs in the solution, then proceed to the procedure.

General rules for the preparation and administration of Ceftriaxone solution for injection

Dilution of Ceftriaxone is essentially no different from the manufacture of solutions of other antibiotics. The standard requirements for the preparation of a solution for injection are as follows:

The substance is prepared immediately before use.
Take the required amount of the drug in powder and a sufficient volume of solvent.
When carrying out an injection, the following condition must be met: you cannot inject more than 1 g of an antibiotic into one buttock.
The drug is injected deeply intramuscularly (almost the entire length of the 5 ml syringe needle) into the upper outer quadrant of the buttock.
Ceftriaxone is infused very slowly during the injection.
The ready-made solution is used exclusively for a single injection, if only part of the contents of the vial is consumed for the injection, the remainder is always thrown away.
The solution of the drug remains stable in physical and chemical properties within 6 hours at room temperature, after this time the medicine must be disposed of.

The quantitative ratio of Ceftriaxone powder to Novocaine will depend on the concentration of the final solution, according to the prescription.

For intramuscular administration, 0.25, 0.5 or 1 g of the antibiotic in the prepared solution can be used. The dosage is determined by the attending physician. In this case, the doctor takes into account the following factors: the type and severity of the pathology, the patient's age, the duration of the disease.

To obtain 1 g of the finished drug, it is necessary to add 5 ml of 0.5% Novocaine from the ampoule to a bottle with 1 g of Ceftriaxone powder. If you reduce the volume of the anesthetic, there is a risk that the antibiotic will not be able to completely dissolve and large particles of the drug will get stuck in the lumen of the needle.

Stages of preparation of novocaine solution of Ceftriaxone

Necessary steps to obtain a solution:

First you need to prepare everything you need: Ceftriaxone lyophilisate in a glass bottle of 1 g or 1000 mg, ampoules with 0.5% Novocaine solution (1 ampoule is 5 ml), a 5 ml syringe, sterile balls and gloves, medical alcohol.
Wash hands with soap, dry, wear medical gloves.
Open the package of the syringe, break off the glass top of the ampoule with Novocaine, bend the aluminum "window" in the central part of the antibiotic bottle lid.
Wipe the rubberized stopper of the Ceftriaxone bottle with an alcohol cotton ball.
Draw 5 ml of Novocaine into a syringe.
Insert the needle through the stopper and slowly pour the anesthetic solution into the bottle.
It is enough to vigorously shake the bottle until the powder completely disappears.
Draw up the required amount of the prepared solution into the syringe.

Thus, a solution with a Ceftriaxone concentration of 1 g or 1000 mg is obtained.

To get other dosages of the antibiotic, you need to follow the same steps, but take different proportions of the drugs:

to prepare 0.5 g or 500 mg of the substance, take 0.5 g of powder and 5 ml of Novocaine;
to obtain 0.25 g or 250 mg, 0.5 g of powder and 10 ml of Novocaine are needed, then half (5 ml) of the resulting solution is drawn into the syringe.

The use of the drug in children

For intramuscular use in children, the drug is most often diluted with sterile water for injection, since the use of Ceftriaxone with Novocaine can lead to the development of a pronounced anaphylactic reaction. The limited use of pain relievers in pediatrics requires extremely slow and careful administration of the antibiotic to minimize pain during the procedure.

Ceftriaxone dilution table for intramuscular injection

Ceftriaxone concentration in a vial, mg	The required dosage of the ready-made solution, mg	Amount of 0.5% Novocaine, ml	Draw in a syringe, ml
1000	1000
1000

To fight bacterial infections, doctors often prescribe the antibacterial drug Ceftriaxone. How to properly dilute it and in what solutions depends on the presence of allergic reactions in a person and on the method of administration of the agent. All this is determined by the doctor. It is important to follow his recommendations exactly. If the drug is prescribed in the form of intramuscular injections, then the pain of the injection can be reduced by using an anesthetic, in particular Novocaine.

Description

Ppowder from almost white to white with a yellowish sheen, hygroscopic.

Composition

Each bottle contains: active substance - ceftriaxone (in the form of ceftriaxone sodium salt) - 500 mg or 1000 mg.

Pharmacotherapeutic group

Antibacterial agents for systemic use. Third generation cephalosporins. PBX code: J01 DD04.

pharmachologic effect

The bactericidal activity of ceftriaxone is due to the suppression of the synthesis of cell membranes of microorganisms. Ceftriaxone acetylates membrane-bound transpeptidases, disrupting the cross-linking of peptidoglycans, which is necessary to ensure the strength and rigidity of the bacterial cell membrane.

Ceftriaxone is active in vitro against most gram-negative and gram-positive microorganisms. Ceftriaxone is highly resistant to most beta-lactamases (both penicillinases and cephalosporinases) of gram-positive and gram-negative bacteria.

The prevalence of acquired resistance can vary geographically and over time for individual species, so local information on resistance to ceftriaxone should be considered when treating severe infections.

Usually sensitive species

Gram-positive aerobes: Staphylococcus aureusа (methicillin-sensitive strains), Staphylococci coagulase-negativeа (methicillin-sensitive strains), Streptococcus pyogenes (group A), Streptococcus agalactiae (group B), Streptococcus. Pneumoniaecci.

Gram-negative aerobes: Borrelia burgdorferi, Haemophilus influenzae, Haemophilus parainfluenzae, Moraxella catarrhalis, Neisseria gonorrhoeae, Neisseria meningitidis, Proteus mirabilis, Providencia spp., Treponema pallidum.

Species that can acquire resistance

Gram-positive aerobes: Staphylococcus epidermidisb, Staphylococcus haemolyticusb, Staphylococcus hominisb.

Gram-negative aerobes: Citrobacter freundii, Enterobacter aerogenes, Enterobacter cloacae, Escherichia colic, Klebsiella pneumoniaec, Klebsiella oxytocac, Morganella morganii, Proteus vulgaris, Serratia marcescens.

Anaerobes: Bacteroides spp., Fusobacterium spp., Peptostreptococcus spp., Clostridium perfringens.

Sustainablekinds

Gram-positive aerobes: Enterococcus spp., Listeria monocytogenes.

Gram-negative aerobes: Acinetobacter baumannii, Pseudomonas aeruginosa, Stenotrophomonas maltophilia.

Anaerobes: Clostridium difficile.

Others: Chlamydia spp., Chlamydophila spp., Mycoplasma spp., Legionella spp., Ureaplasma urealyticum.

Note:

a All methicillin-resistant staphylococci are resistant to ceftriaxone. b resistance rate\u003e 50% in at least one region.

c strains producing an extended range of beta-lactamases are always resistant.

Indications for use

Ceftriaxone sodium salt is indicated for the treatment of the following infections in adults and children, including term infants:

Bacterial meningitis; community-acquired pneumonia; hospital pneumonia; acute otitis media; intra-abdominal infections; complicated urinary tract infections, including pyelonephritis; infections of bones and joints; complicated infections of the skin and soft tissues; gonorrhea; syphilis; bacterial endocarditis.

Ceftriaxone sodium salt can be used for:

Treatment of exacerbation of chronic obstructive pulmonary disease in adults; treatment of disseminated Lyme borreliosis (in the early (stage II) and late (stage III) periods of the disease) in adults and children, including newborns from 15 days of age; preoperative prophylaxis of surgical infections; treating patients with neutropenia and fever suspected of being associated with a bacterial infection; treating patients with bacteremia caused or suspected to be caused by any of the above infections.

Ceftriaxone sodium salt should be administered in conjunction with other antibacterial agents when the possible range of etiological factors does not correspond to its spectrum of action.

Consideration should be given to official guidelines for the proper use of antibacterial agents.

Method of administration and dosage

The dose depends on the type, location and severity of the infection, the sensitivity of the pathogen, the patient's age and the state of his liver and kidney functions.

The doses indicated in the tables below are the recommended doses for these indications. In especially severe cases, the advisability of prescribing the highest doses of the indicated ranges should be considered.

Adults and children over 12 years old (body weight ≥50 kg)

** When prescribing the drug in a dose of more than 2 g per day, the possibility of using the drug 2 times a day is considered.

Indications for adults and children over 12 years of age (body weight ≥ 50 kg) that require special mode of drug administration:

Acute otitis media

As a rule, a single intramuscular injection of the drug in a dose of 1-2 g is sufficient.Limited data indicate that in severe cases or in the absence of an effect from previous therapy, intramuscular administration of ceftriaxone at a dose of 1-2 g per day for 3 days can be effective ...

Preoperative prevention of surgical infections

Single administration before surgery at a dose of 2 g.

Gonorrhea

Single intramuscular injection at a dose of 500 mg.

Syphilis

The recommended doses of 0.5 g or 1 g once a day are increased to 2 g once a day for neurosyphilis, the duration of treatment is 10-14 days. Dosage recommendations for syphilis, including neurosyphilis, are based on limited data. National and local guidelines should be taken into account.

Disseminated Lyme borreliosis (early (II) and late (III) stage)

Apply in a dose of 2 g once a day for 14-21 days. The recommended duration of treatment varies. National and local guidelines should be taken into account.

Application in children

For children weighing 50 kg or more, the doses correspond to those of adult patients. Newborns, infants and children from 15 days to 12 years (body weight

Dose*	Multiplicity of application **	Indications
50-80 mg / kg body weight	Once a day	Intra-abdominal infection. Complicated urinary tract infections (including pyelonephritis) Community-acquired pneumonia Hospital pneumonia
50-100 mg / kg body weight (maximum dose - 4 g)	Once a day	Complicated infections of the skin and soft tissues. Infections of bones and joints. Patients with neutropenia and fever due to bacterial infection.
80-100 mg / kg body weight (maximum dose - 4 g)	Once a day	Bacterial meningitis.
100 mg / kg body weight (maximum dose 4 g)	Once a day	Bacterial endocarditis.

* With established bacteremia, the highest doses from the given range are considered.

** When prescribing a dose of more than 2 g per day, the possibility of using the drug 2 times a day is considered.

Indications for newborns, infants and children from 15 days to 12 years (body weight

Acute otitis media

Limited evidence suggests that in severe cases or in the absence of previous therapy, intramuscular ceftriaxone 50 mg / kg per day for 3 days may be effective.

A single administration before surgery at a dose of 50-80 mg / kg body weight.

Syphilis

The recommended doses are 75-100 mg / kg (maximum - 4 g) of body weight once a day, the duration of treatment is 10-14 days. Dosage recommendations for syphilis, including neurosyphilis, are based on limited data. National and local guidelines should be taken into account.

Disseminated Lyme borreliosis (early (II) and late (III) stage)

Apply in a dose of 50-80 mg / kg body weight once a day for 14-21 days. The recommended duration of treatment varies. National and local guidelines should be taken into account.

Newborns 0-14 days old

Ceftriaxone is contraindicated in premature infants under 41 weeks of age (gestational age + chronological age).

* With established bacteremia, the highest doses from the given range are considered. Do not exceed the maximum daily dose of 50 mg / kg body weight.

Indications for newborns aged 0-14 days, which require a special regimen of drug administration:

Acute otitis media

As a rule, a single intramuscular injection of the drug at a dose of 50 mg / kg of body weight is sufficient.

Preoperative prevention of surgical infections

A single administration before surgery at a dose of 20-50 mg / kg body weight.

Syphilis

The recommended dose is 50 mg / kg of body weight once a day, the duration of treatment is 10-14 days. Dosage recommendations for syphilis, including neurosyphilis, are based on limited data. National and local guidelines should be taken into account.

Duration of therapy

The duration of therapy depends on the course of the disease. Ceftriaxone should be continued for 48-72 hours after the patient's body temperature has returned to normal or the eradication of the pathogen is confirmed.

Use in the elderly

Subject to normal functioning of the kidneys and liver, dose adjustment for elderly patients is not required.

Use in patients with impaired liver function

The available data do not indicate the need for dose adjustment of ceftriaxone for mild to moderate liver dysfunction, provided that renal function is normal. Studies on the use of the drug in patients with severe hepatic impairment have not been conducted.

Use in patients with impaired renal function

The available data do not indicate the need for dose adjustment of ceftriaxone in patients with impaired renal function, provided that liver function is not impaired. In cases of preterminal renal failure (creatinine clearance

Use in patients with severe hepatic and renal impairment

When using ceftriaxone in patients with severe renal and hepatic insufficiency, clinical monitoring of the safety and efficacy of the drug is necessary.

Mode of application

Ceftriaxone should be given as an intravenous infusion for at least 30 minutes (preferred route), intravenously as a slow jet over 5 minutes, or intramuscularly (deep injection).

Intravenous jet injection should be given within 5 minutes, preferably into large veins.

Intravenous doses of 50 mg / kg or more in infants and children under 12 years of age should be given by infusion. In neonates, the duration of the infusion should be more than 60 minutes to reduce the potential risk of bilirubin encephalopathy.

Intramuscular injection should be carried out into large muscles, no more than 1 g should be injected into one muscle. Ceftriaxone should be administered intramuscularly in cases where

it is not possible to administer the drug intravenously, or the intramuscular route of administration is preferred for the patient.

For doses exceeding 2 g, the intravenous route should be used.

Ceftriaxone is contraindicated in newborns if it is necessary to administer calcium preparations or calcium-containing solutions due to the risk of precipitates of ceftriaxone-calcium in the lungs and kidneys.

Due to the risk of sediment formation, calcium-containing preparations (Ringer's solution, Hartmann's solution) should not be used to dissolve ceftriaxone.

Also, precipitates of calcium salts of ceftriaxone can occur when the drug is mixed with solutions containing calcium in the same infusion system for intravenous administration. Therefore, do not mix or simultaneously use ceftriaxone and solutions containing calcium.

For the preoperative prophylaxis of surgical infections, ceftriaxone should be administered 30 to 90 minutes before surgery.

Preparation of solutions

Freshly prepared solutions retain their physical and chemical stability for 6 hours at a temperature not exceeding 25 ° C, and for 24 hours at a temperature of 2-8 ° C in a dark place.

Intramuscular injections: to prepare a solution for intramuscular administration, the contents of the vial (500 mg or 1000 mg) are dissolved in 2 ml or 3.5 ml of water for injection, respectively.

The injection is done deep into the gluteus muscle. It is recommended to inject no more than 1000 mg into one buttock.

Intravenous injection: the concentration of the solution for intravenous injection is 100 mg / ml. To prepare a solution for intravenous injection, the contents of the vial (500 mg or 1000 mg) are dissolved in 5 ml or 10 ml of water for injection, respectively. It is administered intravenously, preferably into large veins, slowly over 5 minutes. Intravenous infusion: concentration for intravenous infusion 50 mg / ml. The intravenous infusion should last at least 30 minutes. To prepare a solution for infusion, dissolve 2 g of Ceftriaxone in 40 ml of one of the following infusion solutions free of calcium ions: 0.9% sodium chloride solution, sodium chloride solution 0.45% + glucose solution 2.5%, glucose solution 5% or 10%, 6% dextran solution in 5% glucose solution, 6-10% hydroxyethylated starch. Given the possible incompatibility, solutions containing ceftriaxone should not be mixed with solutions containing other antibiotics, both during preparation and during administration.

Side effect"type \u003d" checkbox "\u003e

Side effect

The incidence of side effects is given in the following gradation: very often (≥1 / 10); often (≥1 / 100,

The most commonly reported adverse reactions to ceftriaxone are: eosinophilia, leukopenia, thrombocytopenia, diarrhea, rash, and increased serum liver enzymes.

Infections and invasions: infrequently: mycosis of the genital tract; rare: pseudomembranous colitis (mainly caused by Clostridium difficile ); frequency unknown: superinfection.

On the part of the blood and lymphatic system: often: eosinophilia, leukopenia, thrombocytopenia; infrequently: granulocytopenia, anemia, coagulopathy; frequency unknown: hemolytic anemia, agranulocytosis.

From the immune system: frequency unknown: anaphylactic shock, anaphylactic reactions, anaphylactoid reactions, hypersensitivity reactions.

From the nervous system: infrequently: dizziness, headache; frequency unknown: convulsions.

On the part of the organ of hearing and balance: frequency unknown: vestibular dizziness.

From the respiratory system, organs chest and mediastinum: rarely: bronchospasm.

From the gastrointestinal tract: often: diarrhea, loose stools; infrequently: nausea, vomiting; frequency unknown: pancreatitis, stomatitis, glossitis.

From the liver and biliary tract: often: an increase in the amount of liver enzymes in the blood serum (ACT, ALT, alkaline phosphatase); frequency unknown: precipitation of ceftriaxone calcium salt in gallbladder, kernicterus.

On the part of the skin and subcutaneous tissue: often: rash; infrequently: itching; rarely: urticaria; frequency unknown: Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme, acute generalized exanthematous pustulosis.

From the side of the kidneys and urinary tract: rarely: hematuria, glucosuria; frequency unknown: oliguria, kidney precipitate.

General disorders and reactions at the injection site: infrequently: phlebitis, pain at the injection site, pyrexia; rarely: edema, chills.

Laboratory indicators: infrequently: increased serum creatinine concentration; frequency unknown: false positive Coombs' test, false positive test for galactosemia, false positive test for urine glucose. During treatment with ceftriaxone, glucosuria should be determined only by the enzymatic method.

Cases of precipitation in the kidneys have been reported, mainly in children over 3 years old with high daily doses of the drug (≥80 mg / kg / day) or with a cumulative dose of more than 10 g and in the presence of additional risk factors (limited fluid intake, dehydration, limited mobility, bed rest). Precipitation can be symptomatic or asymptomatic, can lead to renal failure and anuria, and is reversible after ceftriaxone treatment is discontinued.

Precipitates of calcium ceftriaxone salt in the gallbladder were observed primarily in patients receiving the drug in doses exceeding the standard recommended dose. In children, in prospective studies with intravenous administration of the drug, there was a different incidence of precipitation of ceftriaxone calcium salt in the gallbladder, in some studies - more than 30%. The incidence of precipitation is less with a slow infusion (20-30 minutes). This effect is usually asymptomatic, but in rare cases, precipitation is accompanied by such clinical symptoms like pain, nausea and vomiting. In these cases, it is recommended symptomatic treatment... Precipitation is usually reversible after ceftriaxone is discontinued.

In case of adverse reactions, including those not listed in this instruction, you should consult a doctor.

Contraindications

hypersensitivity to ceftriaxone, other cephalosporins, or any of the excipients; a history of severe hypersensitivity reactions (eg, anaphylactic reactions) to any other type of beta-lactam antibacterial drugs (penicillins, monobactams, carbapenems); premature infants up to 41 weeks of age (gestational age + chronological age) *; full-term newborns (up to 28 days of life): in the presence of hyperbilirubinemia, jaundice, hypoalbuminemia or acidosis, conditions in which a violation of the binding of-bilirubin * is possible; if they require (or may need) intravenous calcium or calcium-containing solutions due to the risk of precipitating the calcium salt of ceftriaxone.

* In vitro studies have shown that ceftriaxone can displace bilirubin from its association with serum albumin, which increases the risk of bilirubin encephalopathy in these patients.

Lidocaine should not be used as a solvent for any of the routes of administration!

Overdose

Symptoms: nausea, vomiting, diarrhea.

Hemodialysis and peritoneal dialysis do not decrease serum ceftriaxone concentration. There is no specific antidote.

Treatment: symptomatic therapy.

Precautions

Hypersensitivity Reactions: As with other beta-lactam antibacterials, there have been reports of serious and sudden fatal hypersensitivity reactions to ceftriaxone. In the event of severe hypersensitivity reactions, ceftriaxone treatment should be discontinued immediately and adequate treatment measures... Before starting treatment, it should be determined whether the patient has a history of severe hypersensitivity reactions to ceftriaxone, other cephalosporins, or other beta-lactams. Ceftriaxone should be used with caution in patients with a history of mild hypersensitivity reactions to other beta-lactam drugs. There have been reports of severe cutaneous adverse reactions (Stevens-Johnson syndrome or toxic epidermal necrolysis), but the frequency of these reactions is unknown.

Interaction with calcium-containing solutions: cases of deposition of insoluble salts of ceftriaxone calcium in the tissues of the lungs and kidneys have been described in premature and full-term newborns less than 1 month of age, with a lethal outcome. In at least one of these cases, ceftriaxone and calcium were administered at different times and different systems for intravenous administration. In the available scientific data, there are no reports of confirmed cases of intravascular sediment formation in patients other than newborns who received ceftriaxone and calcium-containing solutions or any other calcium-containing drugs. In vitro studies have shown that newborns have an increased risk of calcium ceftriaxone precipitation compared to patients in other age groups.

For patients of any age, calcium-containing solutions (for example, Ringer's solution and Hartmann's solution) should not be used as solvents for diluting ceftriaxone for intravenous administration, or other calcium-containing solutions should be administered simultaneously with ceftriaxone, even when using different venous approaches and different infusion systems. However, for patients over 28 days of age, ceftriaxone and calcium-containing solutions can be administered sequentially one after the other if the infusion systems have different venous access, or if the infusion systems are changed or thoroughly flushed between physiological infusions. salineto avoid sediment formation.

In patients requiring prolonged infusion of calcium-containing parenteral nutrition, the attending physician should consider the use of alternative antibacterial agents for which there is no likelihood of precipitation. If it is not possible to stop using ceftriaxone in a patient requiring continuous feeding, parenteral nutrition and ceftriaxone solutions can be administered simultaneously, but using different intravenous systems in different venous routes. Alternatively, suspend the administration of the parenteral nutrition solution during the administration of ceftriaxone and thoroughly rinse the infusion system between injections of the two solutions.

Use in children: the safety and efficacy of ceftriaxone in children has been established for the doses described in the section "Dosage and Administration". Studies have shown that ceftriaxone, like some other cephalosporins, can displace bilirubin from its association with serum albumin. The use of ceftriaxone is contraindicated in premature and full-term infants at risk of developing bilirubin encephalopathy.

Immunologically mediated hemolytic anemia: there have been cases of development of immunologically mediated hemolytic anemia in patients treated with cephalosporins, including ceftriaxone. Severe cases of hemolytic anemia have been described in adult patients and children, including cases with a fatal outcome. If a patient develops anemia during treatment with ceftriaxone, the likelihood of its development while taking a cephalosporin antibiotic should be assessed and its administration should be discontinued until the etiology of anemia is established.

Long-term therapy: With long-term treatment, complete blood counts should be monitored regularly.

Colitis / Overgrowth of non-susceptible organisms: Antibacterial-associated colitis and pseudomembranous colitis have been reported with almost all antibacterial agents, including ceftriaxone. The severity of colitis can range from mild to life-threatening. Therefore, it is important to consider this diagnosis in patients who have diarrhea during or after treatment with ceftriaxone. Consideration should be given to discontinuing ceftriaxone therapy and prescribing specific treatment for Clostridium difficile. In this case, you should not use drugs that suppress peristalsis. As with the use of other antibacterial agents, superinfections caused by insensitive microorganisms may occur during treatment with ceftriaxone.

Severe hepatic and renal impairment: In severe renal and hepatic impairment, clinical monitoring of safety and efficacy is recommended.

Impact on laboratory tests: during treatment with ceftriaxone, false-positive results of Coombs' test, galactosemia test, determination of glucose in urine (when determining glucose in urine by a non-enzymatic method) may occur. Determination of glucose in urine during the use of ceftriaxone should be carried out enzymatically.

Sodium: One 500 mg vial of Ceftriaxone sodium salt contains approximately 1.8 mmol sodium. One 1000 mg vial of Ceftriaxone sodium salt contains about 3.6 mmol sodium. This must be taken into account in patients on a low sodium diet.

Antibacterial spectrum of action: Ceftriaxone has a limited spectrum of antibacterial action and may not be suitable as the only drug for the treatment of certain types of infections, unless the pathogen has already been confirmed. For polymicrobial infections where suspected pathogens include ceftriaxone-resistant organisms, additional antibiotics should be considered.

Biliary lithiasis: If darkening is observed on ultrasound (echography), the likelihood of precipitation of ceftriaxone calcium should be assessed. Blackouts, mistaken for gallstones, are found on echograms of the gallbladder more often when using ceftriaxone doses of 1000 mg per day or more. Particular care should be taken when using ceftriaxone in pediatric practice. This precipitate disappears after stopping ceftriaxone therapy. Ceftriaxone calcium precipitates are rarely associated with symptoms. In symptomatic cases, it is recommended to carry out conservative treatment and consider the feasibility of discontinuing ceftriaxone therapy based on a specific benefit / risk assessment.

Biliary stasis: Cases of pancreatitis have been reported in patients treated with ceftriaxone, possibly caused by obstruction biliary tract... Most patients had risk factors for biliary stasis and biliary sludge, such as previous primary therapy, severe illness, and total parenteral nutrition. A trigger factor or cofactor for the formation of bile precipitates due to the use of ceftriaxone should not be excluded.

Nephrolithiasis: Cases of reversible nephrolithiasis have been reported, which disappeared after ceftriaxone was discontinued. In symptomatic cases, it is necessary ultrasound procedure (echography). The decision to use ceftriaxone in patients with a history of nephrolithiasis or hypercalcemia should be made by a physician based on a specific assessment of the benefits and risks.

Application during pregnancy and lactation

Pregnancy: Ceftriaxone crosses the placental barrier. Data on the use of ceftriaxone in pregnant women are limited. In animal studies, ceftriaxone did not have a direct or indirect adverse effect on embryo / fetal development, perinatal and postpartum development. Based on this, the use of ceftriaxone during pregnancy is possible if the expected benefit outweighs the potential risk, especially in the first trimester of pregnancy.

Breastfeeding: ceftriaxone is excreted in breast milk in low concentrations and at therapeutic doses has no effect on infant not expected. However, it cannot be ruled out possible risk the development of diarrhea and fungal infection of the mucous membranes. The possibility of sensitization should be taken into account. Breastfeeding should either be discontinued or ceftriaxone should be discontinued / abstained, given the benefits of breastfeeding for the child and the benefits of therapy for the woman.

Fertility: Studies have shown no signs of adverse effects on fertility in men and women.

Influence on the ability to drive vehicles and other potentially dangerous mechanisms

During treatment with ceftriaxone, undesirable effects (for example, dizziness) may occur, which may affect the ability to control transport and other mechanisms (see the "Side Effects" section). Patients should be careful when driving vehicles or other mechanisms.

Interaction with other medicinal products

Calcium-containing drugs: for the preparation of solutions of ceftriaxone for intravenous administration from the powder contained in the vials, or for further dilution of the prepared solution, calcium-containing solvents, such as Ringer's solution or Hartman's solution, must not be used because of the possibility of precipitation. It is also theoretically possible for sediment to form due to the interaction of ceftriaxone and calcium when mixing ceftriaxone with calcium-containing infusion solutions in the same venous access. Ceftriaxone should not be administered concurrently with calcium-containing intravenous solutions, including in the form of continuous infusions of calcium-containing solutions, such as parenteral nutrition solutions through Y-compounds.

It is allowed to administer ceftriaxone and calcium-containing solutions to patients, with the exception of newborns, sequentially one after another, provided that the infusion system is thoroughly rinsed with saline between injections in order to avoid precipitation. In vitro studies using adult plasma and neonatal cord blood have shown that neonates have an increased risk of precipitation due to the interaction of ceftriaxone with calcium.

Oral anticoagulants: Concomitant use of ceftriaxone with oral anticoagulants (drugs of the antivitamin K group) may enhance their effect and increase the risk of bleeding.

Frequent monitoring of the International Normalized Ratio (INR) and appropriate dose selection of antivitamin K group drugs are recommended, both during and after the end of ceftriaxone therapy.

Aminoglycosides: there is conflicting evidence of a possible increase in the nephrotoxicity of aminoglycosides when used simultaneously with

cephalosporins. In such cases, close clinical monitoring of aminoglycoside levels (and renal function) is necessary.

Chloramphenicol: In an in vitro study, antagonism was observed between chloramphenicol and ceftriaxone.

There have been no reports of interactions between ceftriaxone and oral calcium-containing drugs, as well as interactions between ceftriaxone when administered intramuscularly and calcium-containing drugs when administered intravenously or orally. Concomitant use of probenecid does not reduce the elimination of ceftriaxone.

Potent diuretics: with the simultaneous use of large doses of ceftriaxone and potent diuretics (for example, furosemide), no renal impairment was observed.

Vacation conditions

On prescription.

Manufacturer

RUE "Belmedpreparaty",

Republic of Belarus, 220007, Minsk,

st. Fabricius, 30, t./f .: (+37517) 220 37 16,

The action of the drug extends to many microorganisms: some gram-positive and gram-negative aerobes, anaerobic microorganisms.

Prescribing Ceftriaxone

Inflammatory processes of ENT organs;
Frequent diseases of the respiratory system (acute and chronic bronchitis, tracheitis, pneumonia);
Skin and soft tissue infections;
Inflammatory diseases of the genitourinary system of adults and children (acute and chronic cystitis, pyelonephritis, glomerulonephritis, prostatitis, uncomplicated gonorrhea, gynecological diseases);
Infectious processes of the digestive tract (peritonitis, postoperative conditions on the digestive system);
With osteomyelitis (infection of the bones);
With the carriage of salmonella and diseases resulting from its vital activity;
Syphilis (soft chancre) treatment;
With infectious neurological diseases (meningitis, Lyme disease);
For the prevention of the development of infectious processes after various surgical procedures.

Why dilute Ceftriaxone

Since Ceftriaxone is available in powder form, it must be dissolved for administration. The undissolved drug is used only in the form of a powder for bedsores, ulcerative skin lesions and long non-healing wounds. Why dilute Ceftriaxone in patients? This only happens in cases of home treatment. Sometimes sick people refuse medical care and do intramuscular injections on their own with the help of relatives or close people.

Therefore, before the introduction, a test should be made for an allergic reaction to both an antibiotic and an anesthetic. To do this, use an insulin syringe to inject the minimum dose of the drug diluted with water for injection on the wrist. If no changes appear at the injection site after 20 minutes, the drug can be administered.

Dilution of ceftriaxone for intramuscular administration

Provided that the patient does not have allergic reactions to the antibiotic and to the solvent, the drug can be administered. If lidocaine was chosen to reduce pain, then 2 ml of a 2% solution should be drawn into a syringe (as a rule, this is a whole ampoule) and 3 ml of water for injection should be added. This is done to dilute Ceftriaxone thoroughly, as lidocaine is a poor solvent and a fairly strong local anesthetic. Use scissors to open the metal cap on the bottle. Treat the rubber stopper with an alcohol solution before inserting the needle. Shake the bottle thoroughly until completely dissolved. Ready solution of Ceftriaxone for intramuscular use is drawn back into the syringe.

Dilution table of Ceftriaxone with lidocaine 2% for intramuscular injection

Ceftriaxone dose (available)	Ceftriaxone dose (get)	Lidocaine 2%, ml.	Injection water	Draw in a syringe
1 g	1 g	2 ml.	2 ml.	Everything (4 ml.)
1 g	0.5 g	2 ml.	2 ml.	Half (2 ml.)
1 g	0.25 g.	2 ml.	2 ml.	Quarter (1 ml.)
0.5 g. 2 bottles	1 g	1 ml. in every	1 ml. in every	4 ml.
0.5 g	0.5 g	1 ml.	1 ml.	Everything (2 ml.)
0.5 g	0.25 g.	1 ml.	1 ml.	Half (1 ml.)

Dilution of ceftriaxone for intravenous use

Contraindications and individual intolerance to Ceftriaxone

Hypersensitivity to antibiotics from the cephalosporin group (if the patient has had reactions to drugs of the penicillin group, then the likelihood of a cross-allergic reaction to Ceftriaxone increases).
Premature babies (before prescribing the drug, the pediatrician takes into account the need for such therapy, having previously calculated the gestational age and age after birth).
Elevated blood bilirubin levels in premature and newborn babies. This is due to the property of Ceftriaxone to displace the bilirubin molecule from the bond with blood plasma albumin. This condition can trigger the development of encephalopathy.
Treatment with ceftriaxone is prohibited in the first trimester of pregnancy, since it is during this period that there is the greatest risk of mutations.
Breastfeeding period - as the drug is infiltrated into breast milk. During this period, feeding should be postponed until the end of treatment.
Hepatic renal failure is a contraindication to treatment with Ceftriaxone. If, for medical reasons, the doctor is forced to prescribe this drug, you should monitor the indicators of the functional state of the kidneys and liver.

Have you used Ceftriaxone or treated with other drugs?

Ceftriaxone treatment of infectious diseases

How to dilute ceftriaxone for injection

Ceftriaxone intramuscularly - how to dilute

IV ceftriaxone - how to dilute

Important to remember:

Ceftriaxone: how to dilute with lidocaine and water for injection

What diseases is Ceftriaxone used for?

Why dilute Ceftriaxone

Dilution of Ceftriaxone with Lidocaine

Dilution of the antibiotic ceftriaxone for intravenous use

The use of Ceftriaxone when carrying a child and breastfeeding a child

Use of the drug Ceftriaxone for a child's body

Contraindications to the use of this medication

Complications from taking Ceftriaxone

Side effects of using Ceftriaxone

Antibiotic Ceftriaxone: appointment, use, how to properly dilute at home

Prescribing Ceftriaxone

Why dilute Ceftriaxone

Dilution of ceftriaxone for intramuscular administration

Dilution of ceftriaxone for intravenous use

Contraindications and individual intolerance to Ceftriaxone

Instructions for use Ceftriaxone, how to dilute for injections

Purpose and features of using the drug

What is the best way to dilute the drug?

Correct dosages

Dosages for children, during pregnancy and lactation

Contraindications and possible complications

Release form and solutions for diluting the antibiotic

Features of Ceftriaxone injections

General rules for the preparation and administration of Ceftriaxone solution for injection

Stages of preparation of novocaine solution of Ceftriaxone

The use of the drug in children

Method of administration and dosage

Side effect

Contraindications

Overdose

Precautions

Vacation conditions

Prescribing Ceftriaxone

Why dilute Ceftriaxone

Dilution of ceftriaxone for intramuscular administration

Dilution of ceftriaxone for intravenous use

Contraindications and individual intolerance to Ceftriaxone

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