Ceftriaxone – safety in neonates Ceftriaxone has a broad spectrum of in vitro activity and is used in neonates for treating gonococcal ophthalmia and as a second line drug for sepsis

Ceftriaxone – safety in neonates Ceftriaxone has a broad spectrum of in vitro activity and is used in neonates for treating gonococcal ophthalmia and as a second line drug for sepsis and meningitis. It can precipitate if used together with calcium leading to severe reactions including neonatal death. Other possible adverse events of significance in the neonate include biliary sludging, kernicterus and increased chances of invasive candidiasis. Third generation cephalosporin use can also lead to an increase in infections due to Extended spectrum beta lactamase (ESBL) producing organisms. A recent FDA alert advocates that ceftriaxone should not be mixed with calciumcontaining products and not administered in the same or different infusion lines or sites in any patient within 48 hours of each other. This can be problematic in neonates especially in those requiring total parenteral nutrition. A letter (Nov, 2006) to health professionals from AFSSAPS, France states that ceftriaxone is contra indicated in premature infants till 41 weeks of age (GA at delivery + wks after birth) and in term neonates less than 28 days if there is hyper bilirubinemia or if receiving calcium. BNF C recommends caution in preterm neonates and states it is contra indicated in neonates with jaundice, hypoalbuminemia, acidosis or impaired bilirubin binding. It is administered either IM or IV. Maximum single dose for neonates is 150mg. The strengths commercially available are 250 mg, 500mg and 1gm as powder for injection.