Cephalosporins類抗生素 (三四代)

Bloodstream infection: Caused by S. aureus, S. pneumoniae, E. coli, H. influenzae, or K. pneumoniae
Bone and joint infections: Caused by S. aureus, S. pneumoniae, E. coli, Proteus mirabilis, K. pneumoniae, or Enterobacter spp
Gonococcal infection (cervical/urethral, rectal, and pharyngeal): Caused by N. gonorrhoeae
Intra-abdominal infection, mild to moderate, community acquired in patients without risk factors for resistance or treatment failure: Caused by E. coli, K. pneumoniae, Bacteroides fragilis, Clostridium spp
Lower respiratory tract infections (pneumonia, community-acquired): Caused by S. pneumoniae, S. aureus, H. influenzae, K. pneumoniae, E. coli, P. mirabilis, or Serratia marcescens
Meningitis, bacterial: Caused by H. influenzae, Neisseria meningitidis, or S. pneumoniae.
Otitis media, acute: Caused by S. pneumoniae, H. influenzae, or Moraxella catarrhalis
Pelvic inflammatory disease (mild to moderate): Caused by N. gonorrhoeae
Skin and soft tissue infections: Caused by S. aureus, S. epidermidis, Streptococcus pyogenes, viridans group streptococci, E. coli, Enterobacter cloacae, K. oxytoca, K. pneumoniae, P. mirabilis, Morganella morganii, S. marcescens, Acinetobacter calcoaceticus, B. fragilis, or Peptostreptococcus spp
Surgical prophylaxis, colorectal: To reduce the incidence of postoperative infections in patients undergoing surgical procedures classified as contaminated or potentially contaminated
Urinary tract infection, complicated: Caused by E. coli, P. mirabilis, Proteus vulgaris, M. morganii, or K. pneumoniae

Antibiotic, Cephalosporin (Third Generation)

Absorption
(IM) Well absorbed
Distribution
1. Widely throughout the body including gallbladder, lungs, bone, bile, CSF (higher concentrations achieved when meninges are inflamed)
(1) Neonates: Vd 0.34 to 0.55 L/kg
(2) Infants and Children: Vd 0.32 to 0.4 L/kg
(3) Adults: Vd ~6 to 14 L
(4) CSF: blood ratio ~14%.
(5) Pleural fluid: serum ratio: ~27% to 29%
2. Protein binding: 85% to 95%
Half-life elimination
1. Neonates: 1 to 4 days: 16 hours; 9 to 30 days: 9 hours
2. Infants and Children: 4 to 6.6 hours
3. Adults: Normal renal and hepatic function: ~5 to 9 hours
4. Adults: Renal impairment (mild to severe): ~12 to 16 hours
Time to peak
(IM) 2 to 3 hours
Excretion
Urine (33% to 67% as unchanged drug); feces (as inactive drug).

1. Must not be co-administered with calcium-containing solutions or products in newborns, because of risk of fatal salt precipitation in lungs and kidneys.
2. Hypersensitivity to cephalosporins.
3. Hyperbilirubinemic neonates, especially prematures, should not be treated with ceftriaxone.

C; Ceftriaxone crosses the placenta

Ceftriaxone is present in breast milk.

Dermatologic: Skin tightness, skin rash
Local: Induration at injection site, warm sensation at injection site, pain at injection site, tenderness at injection site
Gastrointestinal: Diarrhea
Hematologic & oncologic: Eosinophilia, leukopenia, thrombocythemia
Hepatic: Increased serum transaminases
Renal: Increased blood urea nitrogen

Bloodstream infection (For pathogen-directed therapy of susceptible organisms in the absence of CNS infection):
1. General: IV 2 g once daily; Usual duration is 7 to 14 days
2. For patients with pneumococcal bacteremia: 2 g every 12 hours in combination with vancomycin until meningitis is ruled out.
Intra-abdominal infection, community-acquired (mild to moderate infection in low-risk patients):
IV 1 to 2 g once daily; continue for 1 day after gallbladder removal or until clinical resolution in patients managed nonoperatively.
Meningitis, bacterial:
1. General: IV 2 g every 12 hours; duration is 7 to 21 days, depending on causative pathogen(s) and clinical response.
2. For empiric therapy, use in combination with other appropriate agents.
Osteomyelitis and/or discitis:
IV 2 g every 24 hours, generally for >6 weeks depending on patient-specific factors such as organism, extent of infection, debridement, and clinical response.
Pneumonia, community-acquired (Inpatients without risk factors for P. aeruginosa):
IV 1 to 2 g once daily in combination with other appropriate agent(s)
Prosthetic joint infection:
IV 2 g every 24 hours for 4 to 6 weeks; for empiric therapy, use as part of an appropriate combination regimen.
Skin and soft tissue infection (eg, select surgical site or necrotizing infections):
IV 1 to 2 g once daily, usually as part of an appropriate combination regimen.

1. CrCl >15 mL/minute: No dosage adjustment necessary.
2. CrCl <15 mL/minute: No dosage adjustment necessary. Use of >2 g/day has not been studied and should be done with close monitoring, especially in patients with concurrent hepatic dysfunction.
3. Hemodialysis, Peritoneal dialysis: Poorly dialyzed; no dosage adjustment necessary.
4. CRRT, PIRRT: No dosage adjustment necessary.

There are no dosage adjustments provided in the manufacturer's labeling; however, in patients with concurrent hepatic dysfunction (impaired biliary excretion) and severe kidney impairment, use of >2 g/day should be done with caution and close monitoring for toxicity