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Ceftriaxone uses, advantages and disadvantages.
Yuritza Medina
Florida National University
Ceftriaxone is an antibiotic used to treat many kinds of bacterial infections, including severe or life-threatening forms such as meningitis, Acinetobacter and Enterobacter species, hemophilic influenzae (including beta lactamase producing strains), Klebsiellosis pneumoniae, organelle, Neisseria and Proteus species, and Serratia marcescens. It possesses activity against most strains of Staphylococcus aureus and Streptococcus pneumoniae, but Staphylococcus epidermidis, methicillin-resistant strains of staphylococcus, and Enterococcus faecalis (Group D streptococci) are typically resistant. Ceftriaxone has poor activity against anaerobes. Ceftriaxone has a long serum life, time that the drug takes for its concentration in the body to reduce by half compared to other antibiotics for bacterial infections. This allows it to be taken after twelve hours in children and twenty four hours in adults. However the use of Ceftriaxone causes leads to serious side effects that include severe skin reactions. The skin reactions include burning of the eyes, swelling of face or tongue, skin pain, blistering and peeling of the skin. It also causes serious allergic reactions such as hives and breathing difficulties on individuals allergic to any of its ingredients. Ceftriaxone is commonly used in the treatment of acute gonorrhea of the lining of the uterine walls. Ceftriaxone is generally recognized to be safe and effective when administered either intravenously or intramuscularly to both adults and children as a single drug for skin and skin structure infections. An advantage of ceftriaxone over the other third-generation cephalosporins is its long serum half-life, which allows it to be given every 12 hours in children and every 24 hours in most adults. There is no question that ceftriaxone is effective for skin and soft tissue infections, particularly those caused by staphylococci and streptococci. The drug’s sales to home infusion companies around the country attest to its widespread use for such infections.
The fact remains, however, that the data required to substantiate efficacy and safety for ceftriaxone or for any of the other third-generation cephalosporins are just not available in large numbers. There are some disadvantages in the use of ceftriaxone for example, the costs involved in the acquisition and administration of ceftriaxone must be weighed against its convenience in the out-patient setting. Single-dose therapy is still significantly more expensive than oral antibiotics in most areas. In addition, concern exists with the potential for the development of bacterial resistance with overuse of this agent in children. Issues such as these must be more fully evaluated before clinicians adopt the wide-spread use of ceftriaxone for relatively self-limiting conditions such as otitis media. Ceftriaxone is poorly absorbed from the gastrointestinal tract and must be given parenterally. Like other cephalosporins, it is widely distributed throughout the body. It reaches the cerebrospinal fluid in adequate concentrations through inflamed meninges to effectively treat meningitis. Unlike most other cephalosporins, ceftriaxone is highly protein-bound. Controversy remains over the significance of ceftriaxone’s displacement of bilirubin from protein binding sites in neonates. Although several clinical trials have documented the safety of ceftriaxone in the neonatal population, many clinicians continue to avoid its use in this population, particularly in premature neonates or those with hyperbilirubinemia. Ceftriaxone is 60 to 70% eliminated as unchanged drug by renal excretion. The remainder is secreted unchanged in the bile. The long elimination half-life of ceftriaxone, approximately 6 to 9 hours in adults and 5 to 18 hours in infants and children, allows for once or twice daily dosing.
References
Truter, I. (January 01, 2015). Antimicrobial prescribing in South Africa using a large pharmacy database: a drug utilization study: original research – autopsies at an academic hospital. Southern African Journal of Infectious Diseases, 30, 2, 52-56.