Multiple IV or IM doses ranging from 0.5 to 2 g at 12 to 24 hour intervals resulted in 15% to 36% accumulation of ceftriaxone above single dose values.Thirty-three percent to 67% of a ceftriaxone dose was excreted in the urine as unchanged drug and the remainder was secreted in the bile and ultimately found in the feces as microbiologically inactive compounds. Table 1. Sampling times were from 1 to 50 hours after a single intramuscular injection of 50 mg/kg of ceftriaxone. Ceftriaxone 1 g IV q24H Duration 7-14 days Patient severely ill or hospitalized >48 hours Meropenem 1 g IV q8H OR Cefepime 1 g IV q8H OR PCN allergy: Aztreonam 1 g IV q8H Duration 7-14 days Urosepsis SIRS due to urinary tract infection Meropenem 1 g IV q8H OR Cefepime 1 g IV q8H OR PCN allergy: IV therapy does not need to be continued until discharge. Discontinue ceftriaxone sodium in patients who develop signs and symptoms suggestive of gallbladder disease and/or the sonographic findings described above.Ceftriaxone-calcium precipitates in the urinary tract have been observed in patients receiving ceftriaxone and may be detected as sonographic abnormalities. Ceftriaxone crosses the blood placenta barrier.The average values of maximum plasma concentration, elimination half-life, plasma clearance and volume of distribution after a 50 mg/kg IV dose and after a 75 mg/kg IV dose in pediatric patients suffering from bacterial meningitis are shown in Compared to that in healthy adult subjects, the pharmacokinetics of ceftriaxone were only minimally altered in elderly subjects and in patients with renal impairment or hepatic dysfunction (The elimination of ceftriaxone is not altered when ceftriaxone is co-administered with probenecid. 0409-7333-31, Ceftazidime Fortaz ® TOP: Dosing (usual): 1 gram IV q8-12 hours. In a second study comparable cure rates were observed between single dose ceftriaxone and the comparator. A cofactor role of ceftriaxone-related biliary precipitation cannot be ruled out.Considering the maximum duration of treatment and the class of the compound, carcinogenicity studies with ceftriaxone in animals have not been performed. -Urinary tract infections (complicated and uncomplicated) due to E coli, P mirabilis, P vulgaris, Morganella morganii, or K pneumoniae. 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.Rash (1.7%). Protect from light.Ceftriaxone is lower than control at study day 14 and 28.Ceftriaxone is equivalent to control at study day 14 and 28.An open-label bacteriologic study of ceftriaxone without a comparator enrolled 108 pediatric patients, 79 of whom had positive baseline cultures for one or more of the common pathogens. Therapy may be instituted prior to obtaining results of susceptibility testing.To reduce the development of drug-resistant bacteria and maintain the effectiveness of ceftriaxone for injection, USP and other antibacterial drugs, ceftriaxone for injection, USP should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. Ceftriaxone must not be administered simultaneously with calcium-containing IV solutions, including continuous calcium-containing infusions such as parenteral nutrition via a Y-site. In case of severe hypersensitivity reactions, treatment with ceftriaxone must be discontinued immediately and adequate emergency measures must be initiated.Do not use diluents containing calcium, such as Ringer’s solution or Hartmann’s solution, to reconstitute ceftriaxone vials or to further dilute a reconstituted vial for IV administration because a precipitate can form. 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 (see 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. Renal Dosing: [CRCL >30 ml/min]: no changes. Less frequently reported (<1%) were pruritus, fever or chills.Eosinophilia (6%), thrombocytosis (5.1%) and leukopenia (2.1%). The usual duration of therapy is 4 to 14 days; in complicated infections, longer therapy may be required.No dosage adjustment is necessary for patients with impairment of renal or hepatic function (see The dosages recommended for adults require no modification in elderly patients, up to 2 g per day, provided there is no severe renal and hepatic impairment (see Ceftriaxone should be administered intravenously by infusion over a period of 30 minutes, except in neonates where administration over 60 minutes is recommended to reduce the risk of bilirubin encephalopathy.Do not use diluents containing calcium, such as Ringer’s solution or Hartmann’s solution, to reconstitute ceftriaxone for injection vials or to further dilute a reconstituted vial for IV administration. Most patients presented with risk factors for biliary stasis and biliary sludge (preceding major therapy, severe illness, total parenteral nutrition). Vitamin K administration (10 mg weekly) may be necessary if the prothrombin time is prolonged before or during therapy.Concomitant use of ceftriaxone with Vitamin K antagonists may increase the risk of bleeding.