Powerful antibiotic wide range Ceftriaxone is a representative of the 3rd generation of cephalosporins. Optimal action it provides benefits when administered parenterally, but intramuscular injections of this drug are painful and require the use of anesthetics.
Ceftriaxone and Lidocaine are most often used, because this combination provides the best effect.
Action of Ceftriaxone
The drug exhibits an antibiotic effect against many gram-positive and gram-negative pathogens belonging to both anaerobes and aerobic groups, including streptococci and staphylococci, Pseudomonas aeruginosa and coli, pathogens of gonorrhea and meningitis. Its antibacterial activity is based on suppressing the synthesis of murein, which is the most important component of the cell membrane of a microorganism, which impairs its strength and leads to the death of the individual.
Ceftriaxone is different high level bioavailability (100% 2 hours after intramuscular injection) and long-lasting action.
It easily penetrates various tissues and fluids, including the cerebrospinal fluid.
What does Lidocaine help with?
Being a 2nd generation anesthetic drug, Lidocaine is used when local anesthesia is necessary in ophthalmology, surgery, during dental procedures, for injection blockade during severe pain and conducting a series diagnostic measures. It is also prescribed to eliminate arrhythmia and is used as a solvent for antibiotics of the cephalosporin group. It works faster, longer and more effectively than Novocaine, but is a more toxic compound. You can find out more about this drug.
Indications for the simultaneous use of Ceftriaxone and Lidocaine
If Ceftriaxone is administered intramuscularly, a strong pain reaction occurs locally. To eliminate painful sensations, use Lidocaine. With intravenous injections, pain may also occur, spreading along the vein. However, in this case, the drug should not be mixed with an anesthetic, since Lidocaine has a strong effect on cardiac activity.
Ceftriaxone is used for diseases the development of which is caused by pathogens susceptible to its action. Indications for use:
- sepsis;
- meningitis;
- salmonellosis;
- defeat respiratory system, including abscess;
- peritonitis, inflammation in the gastrointestinal tract and gall bladder;
- infections urinary tract and genitals;
- osteoarticular and skin diseases;
- infection of soft tissues, wounds, burn injuries.
Antibiotics are also prescribed to treat patients with weak immunity and for the prevention of infection of patients in the postoperative period.
Contraindications
Lidocaine should not be used for hypotension, severe kidney and liver disease, or allergies to the drug. Caution should be exercised if there are problems with hematopoiesis, as well as when prescribing an anesthetic to pregnant women, nursing mothers, elderly and debilitated patients.
A strict contraindication to the use of Ceftriaxone is individual intolerance to the drug, its analogs, penicillin, or carbapenem antibiotics.
In case of appointment of this medicine newborns with signs of jaundice, premature infants, women during pregnancy or lactation, patients with renal-hepatic abnormalities need to carefully monitor their condition.
How to take Ceftriaxone and Lidocaine
Ceftriaxone is available in powder form. For cooking injection solution it can be mixed with saline in ampoules or buffer containers, with water for injection or with an anesthetic. WHO recommends Lidocaine as a diluent for cephalosporin antibiotics, including Ceftriaxone. Lidocaine solution is suitable only for intramuscular use.
How to dilute Ceftriaxone with Lidocaine
When preparing a medicinal mixture to administer intramuscularly, the following proportions are observed. If a vial of Ceftriaxone 500 mg is used, its contents are mixed with 1 ampoule of Lidocaine (2 ml). Accordingly, 2 ampoules of anesthetic are consumed for 1 g of antibiotic. You need to purchase a 1% anesthetic component. When using Lidocaine 2%, water is added to it in a 1:1 ratio.
How to prick
An injection is made in the center of the upper outer quadrant of the buttock. The solution must be used fresh, injecting it to a sufficient depth. The medicine is administered slowly. It is not advisable to inject more than 1 g of Ceftriaxone into one buttock.
The daily dosage and duration of the treatment course should be determined by the doctor.
In children, the dose depends on age and body weight. From the age of 12 and weighing over 50 kg, the child is given prescriptions as for an adult.
Side effects of drugs
Lidocaine often provokes the development of typical allergic reactions, and anaphylactic shock is possible. Other side effects are also observed:
- increased heart rate;
- decrease in blood pressure;
- headache;
- increased light sensitivity;
- drowsiness.
The administration of antibacterial agents intravenously or intramuscularly is used for moderate and severe disease. Parenteral administration allows:
- significantly increase the bioavailability of the product used;
- accelerate the achievement of maximum therapeutic concentrations in plasma and obtain a visible therapeutic effect much faster;
- exclude the effect of digestive system enzymes on the drug;
- provide first aid to unconscious patients with uncontrollable vomiting or dysphagia (impaired swallowing);
- use drugs that are poorly absorbed or destroyed in the gastrointestinal tract.
Antibiotic injections must be performed in a hospital setting. The attending physician must prescribe medications, as well as calculate the dosage of antibiotic required for administration. Antibiotic dosages are selected individually and depend on the age, weight and severity of the patient’s condition.
To prevent the development of allergic reactions (Quincke's edema, anaphylactic shock), all antibiotics are administered only after a sensitivity test.
Independent choice of the drug and selection of dosages can cause the development of severe side effects.
Before diluting the drug, the nurse should check the labels on the ampoule with the prescription sheet, and also check the expiration date of the ampoule. The packaging with the syringe must be checked for integrity and expiration date. Then a thorough hand hygiene is carried out. After the gloves are put on, they are treated with an alcohol ball.
The package with the syringe must be opened from the piston side. After opening the package, you should connect the needle to the syringe (the protective cap cannot be removed from the needle).
After opening the metal cap on the antibiotic bottle, you should also treat the rubber protective stopper with an alcohol ball.
Next, you need to remove the protective cap from the needle, draw the required solvent into the syringe ( injection water, isotonic physiological solution). After piercing the rubber stopper with a needle, you need to carefully introduce the liquid into the bottle.
After disconnecting the syringe from the needle (the needle remains in the cap), the bottle must be thoroughly shaken until the antibiotic is completely dissolved.
The dissolved drug must be homogeneous, transparent and free of foreign matter. For some antibiotics, a yellowish tint of the solution is allowed.
After the antibiotic has completely dissolved, you need to connect the syringe back to the needle, turn the bottle over and draw out the required amount of medicine.
After collecting the solution, you need to make sure that there are no air bubbles in it. If necessary, turn the syringe over with the needle up, lightly tap the barrel (so that the bubbles rise up) and release the air bubbles.
How to calculate the dose of an antibiotic
Two dilution methods are used - 1:1 and 2:1.
In pediatric practice, a one-to-one dilution is used, and for adults, a two-to-one dilution.
To correctly calculate the dose, you must remember that 1,000,000 units of the drug is equal to 1,000 milligrams (1 gram). Accordingly, 0.5 grams = 500,000 units, 0.25 grams = 250,000 units.
When diluting an antibiotic using the one-to-one method, 1 milliliter of solvent is used per 100,000 units of antibiotic. Accordingly, to dilute 250 thousand units of the drug, add 2.5 milliliters, 500 thousand - five milliliters, 1 million units - 10 milliliters of solvent.
Dilution of antibiotics and calculation of the required dose in neonatology is also carried out on a one-to-one basis.
If an antibiotic is diluted at a rate of two to one, then 0.5 milliliters of solvent is used per hundred thousand units of the drug.
Accordingly, for 250 thousand units 1.25 of solvent is taken, for 500 thousand - 2.5 and for 1 million units - 5 milliliters of solvent.
Rules for diluting antibiotics
When using the one-to-one dilution method, it must be taken into account that each milliliter of the resulting solution will contain 100 thousand units or 100 milligrams medicine. Accordingly, every 0.1 milliliter of solution contains 1000 units or ten milligrams of the drug.
The antibiotic solution must be prepared immediately before administration.
Calculation example:
If we compare the prescriptions of doctors, the drug Ceftriaxone is the leader among antibiotics for parenteral use. Due to its versatility, it is often prescribed for the treatment of various inflammatory processes on an outpatient basis and in a hospital setting.
The drug Ceftriaxone is known not only to health workers, but also to ordinary patients who often suffer from respiratory diseases. Ceftriaxone belongs to the group of 3rd generation cephalosporins and is a broad-spectrum antibiotic. Inhibiting transpeptidase stops the biosynthesis of bacterial cell wall mucopeptide.
The effect of the drug applies to many microorganisms: some gram-positive and gram-negative aerobes, anaerobic microorganisms.
Prescription of Ceftriaxone
The active prescription of Ceftriaxone is observed in the lists of the following departments: therapy, surgery, urology, pediatrics and even venereology. When is Ceftriaxone used? The most common diseases for which Ceftriaxone is used:
- Inflammatory processes of ENT organs;
- Frequent diseases of the respiratory system (bronchitis in acute and chronic conditions, tracheitis, pneumonia);
- Infections skin and soft tissues;
- Inflammatory diseases genitourinary system adults and children (acute and chronic cystitis, pyelonephritis, glomerulonephritis, prostatitis, uncomplicated gonorrhea, gynecological diseases);
- Infectious processes of the gastrointestinal tract (peritonitis, postoperative conditions on the digestive organs);
- For osteomyelitis (infectious bone lesions);
- When carrying salmonella and diseases resulting from its activity;
- Treatment of syphilis (soft chancre);
- For infectious neurological diseases(meningitis, Lyme disease);
- To prevent development infectious processes after various surgical interventions.
Why dilute Ceftriaxone?
Since Ceftriaxone is available in powder form, it must be dissolved before administration. The undissolved drug is used only in the form of a powder for bedsores, ulcerative skin lesions and long-term non-healing wounds. Why dilute Ceftriaxone in patients? This only happens in cases of treatment at home. Sometimes sick people refuse medical care and make intramuscular injections on their own with the help of relatives or close people.
To dilute the drug at home, you must first of all have aseptic conditions. You should also stock up on antiseptics and ask your doctor how to dilute Ceftriaxone yourself. Intramuscular administration of antibiotics is a rather painful procedure, so a 1% solution of lidocaine or 50% novocaine is used to dilute them. These drugs significantly reduce the pain of the injection, but sometimes cause complications. allergic reactions.
Therefore, before administration, you should test for an allergic reaction to both the antibiotic and the anesthetic. To do this, use insulin syringe administer the minimum dose of the drug diluted with water for injection on the wrist. If after 20 minutes no changes appear at the injection site, the drug can be administered.
Dilution of Ceftriaxone for intramuscular use
Provided that the patient does not have allergic reactions to the antibiotic or the solvent, the drug can be administered. If lidocaine was chosen to reduce pain, then you should draw 2 ml of a 2% solution into a syringe (as a rule, this is a whole ampoule) and add 3 ml of water for injection. This is done to thoroughly dilute Ceftriaxone, since lidocaine is a poor solvent and quite strong local anesthetic. Using scissors, open the metal cap on the bottle. Alcohol solution treat the rubber stopper before inserting the needle. Shake the bottle thoroughly until completely dissolved. The prepared solution of Ceftriaxone for intramuscular use is drawn back into the syringe.
Dilution table for Ceftriaxone with lidocaine 2% for intramuscular injections
| Ceftriaxone dose (available) | Ceftriaxone dose (receive) | Lidocaine 2%, ml. | Injection water | Draw into the syringe |
| 1 year | 1 year | 2 ml. | 2 ml. | Everything (4 ml.) |
| 1 year | 0.5 g. | 2 ml. | 2 ml. | Half (2 ml.) |
| 1 year | 0.25 g. | 2 ml. | 2 ml. | Quarter (1 ml.) |
| 0.5 g. 2 bottles | 1 year | 1 ml. in every | 1 ml. in every | 4 ml. |
| 0.5 g. | 0.5 g. | 1 ml. | 1 ml. | Everything (2 ml.) |
| 0.5 g. | 0.25 g. | 1 ml. | 1 ml. | Half (1 ml.) |
To carry out an intramuscular injection of Ceftriaxone solution, use a syringe with two needles, or 2 syringes. Before carrying out the manipulation, the needle should be replaced with a new one. After puncturing the rubber, the old one has become significantly dull, and this can cause additional pain and bruising. For children under 1 year of age, Ceftriaxone is diluted only with water for injection or sodium chloride solution.
Ceftriaxone is administered intramuscularly slowly and deeply. The antibiotic can only be injected into the upper outer quadrant (gluteus muscle). Lumps may form at the injection site. To prevent them, you can make an iodine grid.
Dilution of Ceftriaxone for intravenous use
Most often, when diluting Ceftriaxone for intravenous administration, a 0.09 sodium chloride solution is used. If the dosage does not exceed 1g, then the drug is administered slowly in a stream. In other cases, the solution is administered by dropper over 30 minutes using 100 ml of sodium chloride solution.
Ceftriaxone is administered intravenously only in an office setting medical institution. If the patient insists on treatment at home, then the help of a qualified healthcare professional is required. Ceftriaxone solution for intravenous use should be used immediately after dilution. The drug administered intravenously enters the bloodstream much faster, and accordingly its effectiveness is much higher. In addition, patients experience less unpleasant painful sensations.
Contraindications and individual intolerance to Ceftriaxone
In most cases, Ceftriaxone is tolerated without negative consequences. In some cases, rare reactions occur. Allergic reactions can almost always be avoided because a sensitivity test is performed before starting antibiotic treatment.
- Hypersensitivity to antibiotics from the cephalosporin group (if the patient has had reactions to the drugs penicillin group, then the likelihood of a cross-allergic reaction to Ceftriaxone increases).
- Premature children (before prescribing the drug, the pediatrician takes into account the need for such therapy by first calculating the gestational age and age after birth).
- Increased levels of bilirubin in the blood in premature and newborn babies. This is due to the property of Ceftriaxone to displace the bilirubin molecule from its connection with blood plasma albumin. This condition can provoke the development of encephalopathy.
- Treatment with Ceftriaxone is prohibited in the first trimester of pregnancy since it is during this period that there is the greatest risk of mutations.
- Period breastfeeding- since the drug infiltrates into breast milk. During this period, feeding should be postponed until the end of treatment.
- Hepatic-renal failure is a contraindication to treatment with Ceftriaxone. If, for medical reasons, the doctor is forced to prescribe this drug, you should monitor the indicators functional state kidneys and liver.
If the patient is on hemodialysis, then the concentration of Ceftriaxone in plasma should be regularly determined. Intolerance to Ceftriaxone may occur due to the characteristics of the body. Most often the cause is genetic characteristics or long-term antibacterial therapy in the anamnesis.
Have you used Ceftriaxone or managed with other drugs?
The best solvent for CEFTRIAXONE
What solvent should be used to prepare the antibiotic solution CEFTRIAXONE?The most acceptable solvent for the preparation of CEFTRIAXONE is LIDOCAINE (preferably used to relieve pain during injection) or WATER FOR INJECTION (an injection with water is painful, but only this solvent can be used in patients with an allergy to lidocaine or for intravenous administration).
In all instructions for CEFTRIAXONE (including drugs under a different name, but with the same composition), 1% LIDOCAINE is recommended as a solvent.
1% LIDOCAINE is already contained as a solvent in packages of such drugs as ROSIN, ROCEPHIN, etc. ( active substance-- CEFTRIAXONE).
Advantages of ceftriaxone with solvent in the package:
- no need to buy a solvent separately (figure out which one),
- the solvent ampoule has already been measured required dose solvent, which helps to avoid mistakes when drawing the required amount into the syringe (no need to figure out exactly how much solvent to take),
- in the ampoule with the solvent there is a ready-made solution of 1% lidocaine - there is no need to dilute 2% lidocaine to 1% (in pharmacies it can be difficult to find exactly 1% lidocaine, you have to dilute it additionally with water for injection).
- an antibiotic together with a solvent is more expensive (choose what is more important to you - convenience or cost)
Why should you not use NOVOCAINE as a solvent for CEFTRIAXONE?
NOVOCAINE is not recommended for use as a solvent due to the increased likelihood of developing anaphylactic shock or allergic reactions.Also according to patient observation:
- pain when injecting ceftriaxone removes better lidocaine than novocaine.
- pain during insertion may intensify after insertion not freshly prepared solutions ceftriaxone with novocaine (according to the instructions for the drug, the prepared ceftriaxone solution is stable for 6 hours - some patients practice preparing several doses of ceftriaxone + novocaine solution at once to save antibiotic and solvent (for example, solutions of 250 mg of ceftriaxone from 500 mg powder), otherwise the remainder would have to be thrown away , and for the next injection use a solution or powder from new ampoules).
WATER FOR INJECTIONS used as a solvent for intravenous administration of an antibiotic (lidocaine cannot be used as a solvent in such cases), as well as in cases where the patient has a history of intolerance lidocaine (allergic reaction).
Ceftriaxone belongs to the new generation of drugs. Main purpose antibacterial agent- impact on pathogenic microorganisms.
This antibiotic is usually prescribed for diseases such as:
- infectious and inflammatory diseases of the ENT organs of bacterial etiology;
- inflammatory processes in the respiratory system;
- genitourinary diseases;
- gynecological pathologies;
- venereal diseases in men and women;
- infectious processes in the gastrointestinal tract;
- purulent internal and external diseases, as well as other bactericidal diseases.
You need to know how to properly prepare Ceftriaxone solution from powder for intramuscular injection, then it will provide the expected quality healing effect and will not be too painful. Positive dynamics therapeutic therapy observed already on the 2-3rd day of admission.
Intramuscular injections
The main part of the products produced by modern pharmacology is produced in containers with lyophilized powder. Such compositions are diluted with saline solution, Novocaine or Lidocaine. At intramuscular injections doctors advise diluting Ceftriaxone with Novocaine or Lidocaine . For intravenous injections Isotonic solutions can be used (for example, 5% glucose solution or 0.9% sodium chloride solution).
It is necessary to understand that the therapeutic effect of the drug does not depend on the liquid used. If you dilute Ceftriaxone for injection with Lidocaine, water for injection or Novocaine, there will be no fundamental difference. However, the differences in sensations will be very noticeable. Correct breeding Ceftriaxone can significantly reduce the pain effect.
It should also be remembered that the prepared solution can only be used in freshly prepared form. Ceftriaxone should not be diluted for future use. Even if you put the solution in the refrigerator, it will soon become unusable. In addition, Ceftriaxone is not recommended to be mixed with other antibiotics - this may cause various shapes allergic reactions.
How to dilute the drug for intramuscular use
Before diluting Ceftriaxone for intramuscular administration to an adult or child, It is necessary to check with the specialist who prescribed it what is the best way to dilute the medicine. After all, the comfort of the procedure will largely depend on the product used. Before using the drug in mandatory It is necessary to test for an allergic reaction of the body to the anesthetic and the antibiotic itself.
If you plan to dilute Ceftriaxone with Novocaine, then you should prepare for the fact that the sensations will not be pleasant. Therefore, it is advisable to consult a doctor in advance whether it is possible to dilute the drug with Novocaine and not Lidocainine.
If it is not possible to replace Novocaine with another solvent, for intramuscular injections each dose of Ceftriaxone should be diluted in 5 ml of 0.5% or 1% Novocaine solution.
However, if there are no contraindications to the use of other anesthetics, then it is better to dilute Ceftriaxone with Lidocaine. This is recommended not only by most doctors, but also by the World Health Organization.
Dilution of Ceftriaxone with Lidocaine 1% is done as follows:
- on a bottle with medicinal powder bend the aluminum cap and process it disinfectant(alcohol);
- Ledocoin 1% in a volume of 3.5 ml is added to the bottle with the drug;
- Shake the bottle of medicine thoroughly so that the antibiotic is completely dissolved.
Instead of one percent Lidocaine, you can use Lidocaine 2%. In this case, the anesthetic should be diluted in a 1:1 ratio with water for injection (take 2 ml of Lidocaine 2% to 2 ml special water). Dilute Ceftriaxone for injection with the resulting solvent in the dosage indicated by the doctor, following the instructions above.
Ceftriaxone intravenously
When prescribing Ceftriaxone intravenously, the drug is diluted with saline solution. In some cases, it is safer to dilute the drug with water for injection. At the same time, the introduction of the drug into circulatory system a person is performed with special care and very slowly.
When prescribing an antibiotic in a dose exceeding 1g, it is more advisable to use Ceftriaxone in the form of a dropper instead of an injection. The drip administration procedure should take at least 30 minutes, and one dose of the antibacterial agent should be diluted in 100 ml of solution.
Side effects
Ceftriaxone itself is usually well tolerated. However, in rare cases, allergic reactions of the body cannot be excluded:
- itching, peeling, skin rash, urticaria, swelling, rarely - Quincke's edema;
From the gastrointestinal tract:
- disorders of the digestive tract (nausea, vomiting, constipation, diarrhea, pseudomembranous colitis) and the development of dysbacteriosis;
From the side of hematopoiesis and coagulation:
- anemia, leukopenia, leukocytosis, hypoprothrombinemia;
From the kidneys:
- oliguria, anuria, inflammatory process in interstitial tissue and kidney tubules (interstitial nephritis);
Due to the chemotherapeutic effect of Ceftriaxone - candidiasis.
At intravenous administration phlebitis may develop, and with intramuscular injection - painful sensations at the injection site (especially if the drug is not diluted or diluted incorrectly with water for injection).
Contraindications
Like anyone else drug Ceftriaxone (regardless of how Ceftriaxone is diluted) has its contraindications.
- any allergic reactions to the drug and its components;
- increased bilirubin levels in the blood and liver disease;
- infarction and pre-infarction conditions;
- renal pathologies;
- epilepsy;
- disorders of psycho-emotional state;
- pregnancy and lactation period.
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