Tseftriakson

General characteristics. Structure:

Active ingredient: цефтриаксон;
1 bottle contains a tseftriakson of sodium salt sterile, in terms of цефтриаксон 0,5 g or 1 g.

Pharmacological properties:

Pharmacodynamics. Tseftriakson a parenteral tsefalosporinovy antibiotic of the III generation with the prolonged action. Bactericidal activity of a tseftriakson is caused by oppression of synthesis of cellular membranes. Tseftriakson is active in vitro concerning the majority of gram-negative and gram-positive microorganisms. Tseftriakson is characterized by very big resistance to the majority beta лактамаз (as penicillinases, and цефалоспориназ) gram-positive and gram-negative bacteria. Tseftriakson is active rather following microorganisms of in vitro and at clinical infections (see the section "Indications"):
Gram-positive aerobes. Staphylococcus aureus (metitsillinchuvstvitelny), koagulazootritsatelny staphylococcus, Streptococcus pyogenes (β-hemolitic, groups A), Streptococcus agalactiae (β-hemolitic, groups B), β-hemolitic streptococci (groups And, In), Streptococcus viridans, Streptococcus pneumoniae.
Note. Steady against Staphylococcus spp Methicillinum. rezistentna to cephalosporins, including to a tseftriakson. Also Enterococcus faecalis, Enterococcus faecium and Listeria monocytogenes find resistance to a tseftriakson.
Gram-negative aerobes. Acinetobacter lwoffi, Acinetobacter anitratus (mainly A. baumanii) *, Aeromonas hydrophila, Alcaligenes faecalis, Alcaligenes odorans, alkagenopodobny bacteria, Borrelia burgdorferi, Capnocytophaga spp., Citrobacter diversus (including C. amalonaticus), Citrobacter freundii *, Escherichia coli, Enterobacter aerogenes *, Enterobacter cloacae *, Enterobacter spp. (others) *, Haemophilus ducreyi, Haemophilus influenzae, Haemophilus parainfluenzae, Hafnia alvei, Klebsiella oxytoca, Klebsiella pneumoniae **, Moraxella catarrhalis (raney Branhamella catarrhalis were called), Moraxella osloensis, Moraxella spp. (others), Morganella morganii, Neisseria gonorrhea, Neisseria meningitidis, Pasteurella multocida, Plesiomonas shigelloides, Proteus mirabilis, Proteus penneri *, Proteus vulgaris *, Pseudomonas fluorescens *, Pseudomonas spp. (others) *, Providentia rettgeri *, Providentia spp. (others), Salmonella typhi, Salmonella spp. (netifoidny) Serratia marcescens *, Serratia spp. (others) *, Shigella spp., Vibrio spp., Yersinia enterocolitica, Yersinia spp. (others).
* Some isolates of these types are steady against a tseftriakson mainly owing to education β-лактамаз, coded by chromosomes.
** Some isolates of these types are steady against a tseftriakson owing to formation of a row plazmidooposredovanny β-лактамаз.
Note. Many of strains of the above-mentioned microorganisms having multiple resistance to such antibiotics as aminopenicillin and ureidopenicillin, cephalosporins of the first and second generation, aminoglycosides are sensitive to a tseftriakson. Treponema pallidum is sensitive to a tseftriakson of in vitro and in animal experiments. Clinical tests show that цефтриаксон it is effective for treatment of primary and secondary syphilis, except for the clinical strains of P. Aeruginosa steady against a tseftriakson. Anaerobe bacterias. Bacteroides spp. (sensitive to bile) *, Clostridium spp. (except C. difficile), Fusobacterium nucleatum, Fusobacterium spp. (others), Gaffkia anaerobica (Peptococcus were called earlier), Peptostreptococcus spp.
* Some isolates of these types are steady against a tseftriakson owing to education β-лактамаз. Note. Much of Bacteroides spp strains., the producing beta lactamazu (in particular B. fragilis), are steady against a tseftriakson. Clostridium difficile is steady.
Sensitivity to a tseftriakson can be determined by method of disks or method of serial delution on an agar or broth, using a standard technique, similar to that which is recommended by the National Committee of Clinical Laboratory Standards (NCCLS). For a tseftriakson of NKKLS established such criteria for evaluation of results of tests:

                            Sensitive   Moderately sensitive  Steady
Method of cultivations
The inhibiting concentration, mg/l =                  8 16-32               = 64
Method of disks
(a disk from 30 mkg of a tseftriakson)
Diameter of a zone of a growth inhibition, mm =                 21 20-14                = 13

For definition of sensitivity of microorganisms it is necessary to use disks with tseftriaksony as цефтриаксон it is active rather separate strains steady at use of the disks intended for all group of cephalosporins. Instead of the NKKLS standards, for definition of sensitivity of microorganisms it is possible to use also other well standardized standards, for example, of DIN and ICS allowing to estimate adequately sensitivity level.

Pharmacokinetics. The pharmacokinetics of a tseftriakson has nonlinear character. All key pharmacokinetic parameters which are based on the general concentration of drug except for an elimination half-life, depend on a dose.
Absorption. The maximum concentration in a blood plasma after single intramuscular introduction of 1 g of drug makes 81 mg/l and is reached in 2-3 hours after introduction. The area under a concentration curve in a blood plasma after intravenous administration equals that after intramuscular introduction. It means that bioavailability of a tseftriakson after intramuscular introduction makes 100%.
Distribution. The volume of distribution of a tseftriakson makes 7-12 l. After introduction in a dose of 1-2 g цефтриаксон well gets into fabrics and liquids of an organism. Within more than 24 hours of its concentration much more exceed the minimum overwhelming concentration for the majority of causative agents of infections more than in 60 fabrics and liquids (including lungs, heart, biliary tract, a liver, almonds, a middle ear and a mucous membrane of a nose, bones, and also spinal, pleural and synovial liquids, in a prostate secret). After intravenous administration цефтриаксон quickly gets into cerebrospinal fluid where bactericidal concentration of rather sensitive microorganisms remain within 24 hours.
Linkng with proteins. Tseftriakson reversibly contacts albumine, and extent of binding decreases with concentration growth, for example, decreases from 95% at concentration in a blood plasma less than 100 mg/l to 85% at concentration of 300 mg/l. Thanks to lower concentration of albumine in an intercellular lymph for a free tseftriakson in it higher, than in a blood plasma. Penetration into separate fabrics. Tseftriakson gets through the inflamed meninx at children, including newborns. In 24 hours after intravenous administration of a tseftriakson in a dose of 50-100 mg/kg of body weight (to newborns and babies respectively) concentration of a tseftriakson in cerebrospinal fluid exceed 1,4 mg/l. The maximum concentration in cerebrospinal fluid is reached approximately in 4 hours after intravenous administration and averages 18 mg/l. At bacterial meningitis average concentration of a tseftriakson in cerebrospinal liquid makes 17% of concentration in a blood plasma, at aseptic meningitis of 4%. At adult patients with meningitis after introduction of a dose of 50 mg/kg of body weight in 2-24 hours the concentration of a tseftriakson in cerebrospinal liquid many times exceeding the minimum inhibiting concentration for the most widespread causative agents of meningitis are reached. Tseftriakson gets through a platsentny barrier and in small concentration - into breast milk. Metabolism. Tseftriakson does not give in to system metabolism, and turns into inactive metabolites under the influence of an indestinal flora.
Removal. The general plasma clearance of a tseftriakson equals 10-22 ml/min. The renal clearance equals 5-12 ml/min. of 50-60% of a tseftriakson also 40-50% in not changed view with bile are removed in not changed look by kidneys. The elimination half-life of a tseftriakson at adults makes about 8 hours.
Pharmacokinetics in special clinical cases. At newborns kidneys remove about 70% of a dose. At children is the first 8 days of life, and also at patients 75 years an elimination half-life on average 2-3 times more, than at adults of young age are more senior. At patients with a renal or liver failure the pharmacokinetics of a tseftriakson changes in an insignificant measure, only insignificant increase in an elimination half-life is noted. If only function of kidneys is broken, removal with bile increases if function of a liver is broken, removal by kidneys increases.
Pharmaceutical characteristics.
Main physical and chemical properties: crystal powder of almost white or yellowish color, is poorly hygroscopic. Incompatibility. Tseftriakson it is impossible to mix with kaltsiysoderzhashchy solutions, such as Ringer's solution or Gartman's solution. It is incompatible with amzakriny, Vancomycinum, flukonazoly and aminoglycosides. It is not necessary to mix with other solvents, except those which
are specified in the section "Route of Administration and Doses".

Indications to use:

Treatment of the infections caused by microorganisms, sensitive to drug, including: respiratory infections (especially pneumonia); infections of ENT organs; infections of kidneys and urinary tract; infections of generative organs (including gonorrhea); infections of skin and soft тканин; infections of abdominal organs (peritonitis, infections of biliary tract and digestive tract); sepsis; infections of bones, joints, and also wound fevers; infections at patients with the weakened host defense; meningitis; the disseminated Lyme's borreliosis (early and late stages of a disease). Preoperative prevention of infections at surgical interventions on bodies of a digestive tract, biliary tract, urinary tract and during the gynecologic procedures, but only in case of potential or known contamination. At purpose of a tseftriakson it is necessary to adhere to official recommendations about an antibioticotherapia and, in particular, recommendations about prevention of an antibiotikorezistentnost.

Route of administration and doses:

Tseftriakson apply intramusculary and intravenously. Before therapy using a tseftriakson it is necessary to exclude existence at the patient of intolerance of drug, having taken skin samples. Adults and children are more senior than 12 years: usually appoint 1-2 g of a tseftriakson of 1 times a day (everyone
24 hours). At heavy infections or infections which causative agents have only
moderate sensitivity to a tseftriakson, a daily dose it is possible to increase to 4 g.
Children. Newborns (up to 2 weeks): 20-50 mg/kg of body weight of 1 times a day. The daily dose should not
to exceed 50 mg/kg of body weight. When determining a dose of drug for the full-term and premature children there are no distinctions. Newborns and children from 15 days to 12 years: 20-80 mg/kg of body weight of 1 times a day. To children with body weight over 50 kg appoint doses for adults. Intravenous doses of 50 mg/kg or should be entered by infusion above within at least 30 minutes. Patients of advanced age. Dose adjustment is not necessary to patients of advanced age. Duration of treatment depends on disease. As it is accepted at therapy antibiotics, patients should continue to accept цефтриаксон within at least 48-72 hours after temperature is normalized and analyses show lack of activators. Combination therapy. Rather many gram-negative bacteria there is synergism between tseftriaksony and aminoglycosides. In spite of the fact that the increased efficiency of such combinations can not always be provided, it should be meant in the presence of the heavy, life-threatening infections caused by Pseudomonas aeruginosa. Because of physical incompatibility of a tseftriakson and aminoglycosides they should be entered separately in the recommended doses. Dosing in special cases. At bacterial meningitis at babies and children aged from 15 days up to 12 years treatment begin with a dose 100 mg/kg (but no more than 4 g) 1 time a day. As soon as the activator is identified, and its sensitivity is defined, the dose can be lowered respectively.
The best results were achieved with such duration of treatment:
Neisseria meningitidis     is 4 days old
Haemophilus influenzae     is 6 days old
Streptococcus pneumoniae   is 7 days old
Borellioz Laima: to adults and children - 50 mg/kg (the highest daily dose - 2 g) 1 time a day in
current of 14 days.
For treatment of the gonorrhea (caused by the strains producing and not producing a penicillinase) it is recommended to appoint a single dose of 250 mg intramusculary.
For prevention of postoperative infections in surgery it is recommended depending on degree of danger of infection to enter a single dose of 1-2 g of a tseftriakson in 30-90 minutes prior to operation. At operations on thick and a rectum well proved simultaneous (but separate) introduction of a tseftriakson and one of 5 nitroimidazoles, for example, of an ornidazol. Renal and liver failure. Patients with renal failures do not have need to reduce a dose if function of a liver remains normal. Only in case of a renal failure in a preterminal stage (clearance of creatinine less than 10 ml/min.) the daily dose should not exceed 2 g. Patients with abnormal liver functions do not have need to reduce a dose if function of kidneys remains normal. At a simultaneous heavy renal and liver failure it is regularly necessary to define concentration of a tseftriakson in a blood plasma and to carry out drug dose adjustment in case of need. For the patients who are on a hemodialysis there is no need for additional administration of drug after dialysis. It is necessary to control, however, concentration of a tseftriakson in blood serum regarding possible dose adjustment as at these patients removal speed can decrease. The daily dose of a tseftriakson for the patients who are on a hemodialysis should not exceed 2 g.
Preparation of solutions.
It is necessary to prepare solutions just before their use. Freshly cooked solutions keep the physical and chemical stability within 6 hours at the room temperature (or within 24 hours at a temperature of 2-8 °C). Depending on concentration and storage period color of solutions can vary from pale yellow to amber. This property of active agent does not influence efficiency or portability of drug.
For an intramuscular injection of 1 g dissolve 1% of solution of lidocaine in 3,5 ml; injection
do deeply in a gluteus. It is recommended to enter no more than 1 g into one buttock.
The solution containing lidocaine cannot be entered intravenously.
For an intravenous injection dissolve 1 g of a tseftriakson in 10 ml of sterile water for
injections; enter intravenously slowly (2-4 minutes).
Intravenous injection has to last not less than 30 minutes. For preparation of solution for injection dissolve 2 g of a tseftriakson in 40 ml of one of the following infusion solutions, free from calcium ions: 0,9% sodium chloride, 0,45% sodium chloride + 2, 5% glucose, 5% glucose, 10% glucose, 6% a dextran in solution of glucose of 5%, 6-10% hydroxyethylated starch, water for injections. Considering the possible incompatibility, solutions containing цефтриаксон it is impossible to mix with the solutions containing other antibiotics both at preparation, and at introduction. It is impossible to use kaltsiysoderzhashchy solvents, such as Ringer's solution or Gartman's solution, for dissolution of a tseftriakson in bottles or for cultivation of the recovered solution for intravenous administration in connection with probability of formation of precipitated calcium superphosphates of calcic salts of a tseftriakson. Formation of precipitated calcium superphosphates of calcic salts of a tseftriakson can also happen when mixing a tseftriakson to kaltsiysoderzhashchy solutions in one infusional system for intravenous administration. Tseftriakson it is impossible to enter at the same time intravenously with kaltsiysoderzhashchy solutions, including with long kaltsiysoderzhashchy infusions, for example, parenteral food (see. "Interaction with other medicines and other types of interactions").

Features of use:

As well as at use of other cephalosporins, at use of a tseftriakson anaphylactic reactions with a lethal outcome are possible even if in the detailed anamnesis there are no corresponding instructions. At emergence of allergic reactions цефтриаксон it is necessary to cancel and appoint the corresponding treatment at once. Tseftriakson can increase a prothrombin time. In this regard at suspicion on deficit of vitamin K it is necessary to define a prothrombin time. Against the background of use practically all antibacterial drugs including a tseftriaksona, development of the diarrhea associated with Clostridium difficile from easy severity to colitis with a lethal outcome is possible. Antibacterial drugs change normal flora of a large intestine that leads to Clostridium difficile overgrowth. Clostridium difficile produces the toxins A and B promoting development of the diarrhea associated with Clostridium difficile. Clostridium difficile strains which are excessively producing toxins cause the increased incidence and a lethality as these infections can be resistant to antimicrobic means and demand a colectomy. The diarrhea associated with Clostridium difficile needs to be excluded at all patients during use of antibiotics. It is necessary to collect the detailed medical anamnesis as the diarrhea associated with Clostridium difficile can arise within two months after the end of use of antibacterial agents. At suspicion or confirmation of the diarrhea associated with Clostridium difficile it is necessary to cancel the antibioticotherapia which is not influencing Clostridium difficile. According to clinical indications it is necessary to appoint the corresponding amount of liquid and electrolytes, proteinaceous additives, an antibioticotherapia to which Clostridium difficile and surgical inspection is sensitive. During prolonged use of a tseftriakson difficulties in monitoring microorganisms, insensitive to drug, are possible. In this regard careful supervision of patients is necessary. At development of superinfection it is necessary to take the appropriate measures. After use of a tseftriakson in the doses exceeding standard recommended, at ultrasound examination of a gall bladder shadows which are mistakenly perceived for stones can be observed. These are precipitated calcium superphosphates of calcic salt of a tseftriakson which disappear on end or the termination of therapy tseftriaksony. Similar changes seldom are followed by any symptomatology. But also in such cases only conservative treatment is recommended. If these phenomena are followed by clinical symptomatology, then the decision on drug withdrawal is made by the doctor. At patients to whom entered цефтриаксон isolated cases of the pancreatitis which developed perhaps, owing to obstruction of biliary tract are described. Most of these patients had risk factors of stagnation in biliary tract, for example, treatment in the anamnesis, a serious illness and completely parenteral food. At the same time in development of pancreatitis it is impossible to exclude a role of the precipitated calcium superphosphates formed under the influence of a tseftriakson in biliary tract. Tseftriakson can force out bilirubin from communication with blood serum albumine. In this regard use of a tseftriakson by the newborn with a hyperbilirubinemia is contraindicated (see the section "Contraindications").
It is necessary to apply with care цефтриаксон the patient with a renal failure who is at the same time receiving aminoglycosides and diuretics. Tseftriakson it is impossible to mix or appoint along with kaltsiysoderzhashchy solutions, even at administration of drugs through different infusional systems. At
newborn and premature children cases of formation of precipitated calcium superphosphates in the lungs and kidneys which caused lethal effects at simultaneous introduction of a tseftriakson and drugs of calcium are described.
Cases of formation of intravascular precipitated calcium superphosphates at patients of other age groups after simultaneous use of a tseftriakson with intravenous kaltsiysoderzhashchy solutions are known. In this regard it is impossible to apply kaltsiysoderzhashchy solutions to intravenous administration by the newborn and to patients of other age groups at least within 48 hours after introduction of the last dose of a tseftriakson (see the section "Contraindications"). Immunnooposredovanny hemolitic anemia was observed at the patients receiving cephalosporins, including цефтриаксон. Cases of development of heavy hemolitic anemia, including lethal, at adults and children are known. At development of anemia during use of a tseftriakson it is necessary to exclude the anemia caused tseftriaksony and to cancel drug before establishment of an etiology of anemia. During prolonged treatment it is necessary to control a blood pattern regularly. In isolated cases at treatment tseftriaksony at patients false positive results of reaction of Koombs can be noted. As well as other antibiotics, цефтриаксон the false positive result of test on a galactosemia can cause. False positive results can be received also when determining glucose in urine therefore during treatment tseftriaksony the glucosuria, if necessary, should be determined only by a fermental method. Ability to influence speed of response at control of motor transport or work with other mechanisms. There are no data on influence of a tseftriakson on speed of response, but in connection with possibility of dizziness цефтриаксон can influence ability to manage vehicles or to work with difficult mechanisms.

Side effects:

Usually цефтриаксон it is transferred well. At its use such by-effects regressing spontaneously or after drug withdrawal are possible:
- infections: extended - the mycosis of a genital tract, consecutive fungal infections and infections caused by resistant microorganisms;
- from system of blood and lymphatic system: extended - an eosinophilia, a leukopenia, a granulocytopenia, hemolitic anemia, thrombocytopenia, increase in a prothrombin time; seldom widespread - increase in level of creatinine in blood serum; very seldom widespread - disorders of coagulation. The agranulocytosis (<500/mm3), preferential after use of the general dose of 20 g is very seldom noted or it is more. During prolonged treatment it is necessary to control a blood pattern regularly;
- from a digestive tract: extended - diarrhea, nausea, vomiting, stomatitis, a glossitis; seldom widespread - pancreatitis which developed, perhaps, as a result of obstruction of biliary tract. Most of these patients had risk factors of stagnation in biliary tract, for example, treatment in the anamnesis, a serious illness and completely parenteral food. At the same time in development of pancreatitis it is impossible to exclude a role of the precipitated calcium superphosphates formed under the influence of a tseftriakson in biliary tract; very seldom widespread - a pseudomembranous coloenteritis;
- from gepatobiliarny system: very widespread - precipitated calcium superphosphates of calcic salt of a tseftriakson in a gall bladder with the corresponding symptomatology at children, a reversible cholelithiasis at children (the specified phenomena seldom were observed at children); widespread - increase in level of liver enzymes in blood serum (nuclear heating plant, ALT, an alkaline phosphatase);
- from skin and hypodermic cellulose: extended - a rash, allergic dermatitis, an itch, a small tortoiseshell, hypostases, a dieback; very seldom widespread - an exudative multiformny erythema (Stephens-Johnson's syndrome), a toxic epidermal necrolysis (Lyell's disease);
- from an urinary system: seldom widespread - an oliguria, a hamaturia, a glucosuria; very seldom widespread - formation of concrements in kidneys, mainly at children aged from 3 years receiving high daily doses of drug (≥ 80 mg/kg for days), or cumulative doses over 10 g, and also in the presence of accessory factors of risk (the limited use of liquid, a bed rest). Formation of concrements in kidneys can proceed asymptomatically or clinically be shown, can entail a renal failure which passes after the treatment termination tseftriaksony;
- general frustration: seldom widespread - a headache and dizziness, fever, a fever, and also anaphylactic or anaphylactoid reactions. In isolated cases inflammatory reactions of a wall of a vein are observed. They can be avoided, applying a slow injection (2-4 minutes). The intramuscular injection without use of lidocaine is painful;
- influence on results of laboratory analyses: in isolated cases at treatment tseftriaksony at patients false positive results of reaction of Koombs can be noted. As well as other antibiotics, цефтриаксон the false positive result of test on a galactosemia can cause. False positive results can be received also when determining glucose in urine therefore during treatment tseftriaksony the glucosuria, if necessary, should be determined only by a fermental method.

Interaction with other medicines:

It is impossible to apply цефтриаксон with kaltsiysoderzhashchy solutions at all (Ringer's solution and so forth)! It is not necessary to appoint Kaltsiysoderzhashchy solutions within 48 hours after the last introduction of a tseftriakson. At newborn and premature children cases educations of precipitated calcium superphosphates in the lungs and kidneys which entailed lethal effects at simultaneous introduction of a tseftriakson and drugs of calcium are had. At simultaneous use of high doses of a tseftriakson and such strong diuretics as furosemide, renal failures were not observed. There are no data on what цефтриаксон increases renal toxicity of aminoglycosides. After alcohol intake right after reception of a tseftriakson the effects similar to action of Disulfiramum (Teturamum) were not observed. Tseftriakson does not contain N-methylthiotetracindery group which could cause intolerance of ethanol, and also bleedings that is peculiar to some other
to cephalosporins. Probenetsid does not influence removal of a tseftriakson. There is an antagonism between chloramphenicol and tseftriaksony. It is impossible to use kaltsiysoderzhashchy solvents, such as Ringer's solution or Gartman's solution for dissolution of a tseftriakson in bottles or for cultivation of the recovered solution for intravenous administration in connection with probability of formation of precipitated calcium superphosphates of calcic salts of a tseftriakson. Formation of precipitated calcium superphosphates of calcic salts of a tseftriakson can also happen when mixing a tseftriakson to kaltsiysoderzhashchy solutions in one infusional system for intravenous administration. Tseftriakson it is impossible to enter
intravenously along with kaltsiysoderzhashchy solutions, including with long kaltsiysoderzhashchy infusions, for example, parenteral food (see the section "Route of Administration and Doses"). At babies the risk of formation of precipitated calcium superphosphates of calcic salts of a tseftriakson is increased.
Tseftriakson is incompatible with amzakriny, Vancomycinum, flukonazoly and aminoglycosides. Bacteriostatic means can influence bactericidal effect of cephalosporins. Tseftriakson can reduce efficiency of hormonal oral contraceptives. In this regard it is recommended to apply additional (non-hormonal) methods of contraception during treatment and within 1 month after treatment. There are no messages on interaction between tseftriaksony and kaltsiysoderzhashchy products for oral administration, and interaction between tseftriaksony at an intramuscular injection and kaltsiysoderzhashchy products (intravenously or orally).

Contraindications:

Hypersensitivity to cephalosporins (in the presence at the patient of hypersensitivity to penicillin it is necessary to consider a possibility of cross allergic reaction to a tseftriakson); age of premature children ≤ 41 weeks, considering the term of pre-natal development (gestational age + age after the birth); a hyperbilirubinemia at newborn and premature (in connection with ability of a tseftriakson to force out bilirubin from communication with blood serum albumine that can result in risk of development of the encephalopathy caused by bilirubin). Tseftriakson is contraindicated for use by newborn age ≤ 28 days if necessary (or the expected need) treatments by intravenous kaltsiysoderzhashchy solutions, including intravenous kaltsiysoderzhashchy injections, for example, parenteral food, in connection with risk of formation of precipitated calcium superphosphates of calcic salts of a tseftriakson.

Use during pregnancy or feeding by a breast.
Tseftriakson gets through a placental barrier. Safety of use of a tseftriakson for women during pregnancy was not studied. In small concentration цефтриаксон gets into breast milk. Therefore at purpose of a tseftriakson feeding by a breast needs to be stopped.
Children.
Drug is used to children according to the dosing specified in the section "Route of Administration and Doses".

Overdose:

In case of overdose the hemodialysis or peritoneal dialysis will not reduce concentration of drug. The specific antidote does not exist. Overdose treatment symptomatic.

Storage conditions:

Period of validity 3 years. To store in original packaging at a temperature not above 25 °C. To store in the place, unavailable to children.

Issue conditions:

According to the recipe

Packaging:

On 0,5 g or 1 g in bottles; 10 bottles in a pack.