A Drug Study on

Rocephin

In partial Fulfillment of the Requirements in NCM 209 – RLE

PEDIATRIC NURSING ROTATION

Submitted to
Johanna Zehender, RN
Clinical Instructor

Submitted by
Jhulia Anne F. Gamutin, St. N
Bachelor of Science in Nursing, 2nd Year Section B

January 23, 2021

Generic Name: Ceftriaxone Sodium

Brand Name: Rocephin

Classification: 3rd Generation Cephalosporin Antibiotics

Ordered Dose and Frequency: N/A

Suggested Dose: Rocephin is injected intramuscularly and intravenously. For Neonates Intravenous doses should be given over 60
minutes in neonates to reduce the risk of bilirubin encephalopathy. Meanwhile Pediatric patients’ dose are as follows: For the treatment
of skin and skin structure infections, the recommended total daily dose is 50 to 75 mg/kg given once a day (or in equally divided doses
twice a day). The total daily dose should not exceed 2 grams. For the treatment of acute bacterial otitis media, a single intramuscular
dose of 50 mg/kg (not to exceed 1 gram) is recommended. For the treatment of serious miscellaneous infections other than meningitis,
the recommended total daily dose is 50 to 75 mg/kg, given in divided doses every 12 hours. The total daily dose should not exceed 2
grams. In the treatment of meningitis, it is recommended that the initial therapeutic dose be 100 mg/kg (not to exceed 4 grams).
Thereafter, a total daily dose of 100 mg/kg/day (not to exceed 4 grams daily) is recommended. The daily dose may be administered
once a day (or in equally divided doses every 12 hours). The usual duration of therapy is 7 to 14 days. For treatment for Endocarditis,
recommended daily dose is 100 mg/kg IV or IM every 24 hours (not exceeding 2 grams/day) for infection due to viridans group
streptococci, S bovis, or HACEK microorganisms or documented Bartonella endocarditis (culture positive)

Mode of Action: Ceftriaxone, a beta-lactam antibiotic, is mainly bactericidal. Penicillin Binding Proteins are responsible for several
steps in cell wall synthesis. Bactericidal activity results from inhibiting cell-wall synthesis by binding to 1 or more penicillin-binding
proteins; exerts antimicrobial effect by interfering with synthesis of peptidoglycan (major structural component of bacterial cell wall);
bacteria eventually lyse because activity of cell-wall autolytic enzymes continues while cell-wall assembly is arrested.

Indications: Rocephin 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. Following infections when caused by susceptible organisms: Lower respiratory infections, Acute bacterial otits
Media, Skin and Skin structure Infections, Urinary tract Infections, Uncomplicated Gonorrhea, Pelvic Inflammatory Disease, Bacterial
Septicemia, Bone and Joint Infections, Intra-abdominal Infections, Meningitis, Surgical Prophylaxis, Endocarditis

Contraindications: Rocephin is contraindicated in patients with known hypersensitivity to ceftriaxone, 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 ceftriaxone. Also contraindicated in premature neonates up to a postmenstrual age of 41 weeks
(gestational age + chronological age). Hyperbilirubinemic neonates should not be treated with Rocephin. Ceftriaxone can displace
bilirubin from its binding to serum albumin, leading to a risk of bilirubin encephalopathy in these patients. In neonates (≤ 28 days),
Rocephin is contraindicated, 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 ceftriaxone-calcium. Lastly,
Intravenous administration of ceftriaxone solutions containing lidocaine is contraindicated.

Drug Interaction: Ceftriaxone must not be mixed or administered simultaneously with IV solutions containing calcium salts, including
certain TPN formulas of amino acids with electrolytes formulas such as; Calcium Acetate, Calcium Chloride, and Calcium Gluconate.
Loop Diuretics such as Bumetanide, Ethacrynic Acid, Furosemide, etc. may potentiate nephrotoxicity associated with ceftriaxone. Oral
Contraceptives; It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to
stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. If used with antibiotics, sodium picosulfate;
magnesium oxide; anhydrous citric acid may reduce efficacy of the bowel preparation as conversion of sodium picosulfate to its active
metabolite (BHPM) wherein it is mediated by colonic bacteria. Warfarin, when associated with antibiotics such as cephalosporins may
increase the INR thereby potentiating the risk for bleeding.

Side Effects: Rocephin is generally well tolerated. Yet in clinical trials, the following adverse reactions, which were considered to be
related to Rocephin therapy or of uncertain etiology, were observed: Local Reactions - pain, induration and tenderness was 1% overall.
Phlebitis was reported in <1% after IV administration. The incidence of warmth, tightness or induration was 17% (3/17) after IM
administration of 350 mg/mL and 5% (1/20) after IM administration of 250 mg/mL. General Disorders and Administration Site
Conditions - injection site pain (0.6%). Hypersensitivity - rash (1.7%). Less frequently reported (<1%) were pruritus, fever or chills.
Infections and Infestations - genital fungal infection (0.1%). Hematologic - eosinophilia (6%), thrombocytosis (5.1%) and leukopenia
(2.1%). Less frequently reported (<1%) were anemia, hemolytic anemia, neutropenia, lymphopenia, thrombocytopenia and
prolongation of the prothrombin time. Blood and Lymphatic Disorders - granulocytopenia (0.9%), coagulopathy (0.4%).
Gastrointestinal - diarrhea/loose stools (2.7%). Less frequently reported (<1%) were nausea or vomiting, and dysgeusia. The onset of
pseudomembranous colitis symptoms may occur during or after antibacterial treatment. Hepatic - elevations of aspartate
aminotransferase (AST) (3.1%) or alanine aminotransferase (ALT) (3.3%). Less frequently reported (<1%) were elevations of alkaline
phosphatase and bilirubin. Hepatic - elevations of aspartate aminotransferase (AST) (3.1%) or alanine aminotransferase (ALT) (3.3%).
Less frequently reported (<1%) were elevations of alkaline phosphatase and bilirubin. Renal - elevations of the BUN (1.2%). Less
frequently reported (<1%) were elevations of creatinine and the presence of casts in the urine. Central Nervous System - headache or
dizziness were reported occasionally (<1%). Genitourinary - moniliasis or vaginitis were reported occasionally (<1%).
Miscellaneous - diaphoresis and flushing were reported occasionally (<1%). Investigations - blood creatinine increased (0.6%). Other
rarely observed adverse reactions (<0.1%) include abdominal pain, agranulocytosis, allergic pneumonitis, anaphylaxis, basophilia,
biliary lithiasis, bronchospasm, colitis, dyspepsia, epistaxis, flatulence, gallbladder sludge, glycosuria, hematuria, jaundice,
leukocytosis, lymphocytosis, monocytosis, nephrolithiasis, palpitations, a decrease in the prothrombin time, renal precipitations,
seizures, and serum sickness.

Nursing Responsibilities:

Nursing Responsibilities Rationale

Determine the history of hypersensitivity reactions to Presence of any allergic reactions may affect the use of this
cephalosporins and penicillins and history of other allergies, medicine
particularly to drugs, before therapy is initiated.
Perform culture and sensitivity tests before initiation of therapy To find out the minimal concentration of an antibiotic is necessary
and periodically during therapy. to inhibit the growth of a bacteria. It helps us make the best
decision in antibiotic medication choice.

Inspect injection sites for induration and inflammation. Rotate Common side effects of Rocephin upon administration of

sites. Note the IV injection sites for signs of phlebitis (redness, medication on injection sites are swelling, redness, pain, a hard

swelling, pain). lump or soreness.

Monitor for manifestations of hypersensitivity. Report their Beta-lactam antibacterial agents, can lead to serious and fatal

appearance promptly and discontinue drug. hypersensitivity reactions

Watch for and report signs: petechiae, ecchymotic Ceftriaxone decreases the activity of hepatic microsomal

areas, epistaxis, or any unexplained bleeding. carboxylase and disrupts the metabolism of vitamin K, which can
lead to coagulation disorder and bleeding.

Check for fever if diarrhea occurs: Report both promptly. Ceftriaxone is one of the most commonly associated with
Clostridium difficile infection. Which leads to
Psuedomembranous colitis, swelling of the large intestine. The
infection is a common cause of diarrhea after antibiotic use.

Inform the patient or family members to report any signs of Ceftriaxone decreases the activity of hepatic microsomal

bleeding carboxylase and disrupts the metabolism of vitamin K, which can

lead to coagulation disorder and bleeding.

Inform patient to report loose stools or diarrhea promptly. Antibiotic medicines can cause diarrhea and can be a sign of new
signs of infection.

Do not breastfeed while taking this drug without consulting a Many drugs are not compatible with lactation, they negatively

physician. affect milk composition and production. Having antibiotics while

breastfeeding is harmful to the health and slows down baby’s
development.
 Give teachings to the patient to use the medicine for the full Skipping doses can increase the risk of infection that is resistant

prescribed length of time to medication.

References:

WebMD. (2020 October, 16). Rocephin. Rxlist. Rocephin (Ceftriaxone): Uses, Dosage, Side Effects, Interactions, Warning
(rxlist.com)

Stewart, J. (2020 October 7). Rocephin Injections. Drugs.com. Rocephin: Uses, Dosage & Side Effects - Drugs.com

Medscape. (2021). Ceftriaxone (Rx). Rocephin (ceftriaxone) dosing, indications, interactions, adverse effects, and more
(medscape.com)

Prescriber’s Digital Reference. Ceftriaxone – Drug Summary. Ceftriaxone (ceftriaxone) dose, indications, adverse effects,
interactions... from PDR.net

Multum, C. (2020 September 15). Ceftriaxone (injection). Drugs.com. Ceftriaxone injection Uses, Side Effects & Warnings -
Drugs.com

RNspeak. (2018 May 21). Ceftriaxone Drug Study. Ceftriaxone Drug Study (rnspeak.com)