CEFTRIAXONE (ceftriaxone sodium)

There are 1 contraindications. These drug combinations generally should not be dispensed or administered to the same patient. A manufacturer label warning that indicates the contraindication warrants inclusion of a drug combination in this category, regardless of clinical evidence or lack of clinical evidence to support the contraindication.

Drug Interaction

Drug Names

Live Typhoid Vaccine/Antimicrobials SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: The antimicrobial may be active against the organism in the live-vaccine. Antimicrobial therapy may prevent the vaccine organism from replicating enough to trigger an immune response.(1) CLINICAL EFFECTS: Vaccination may be ineffective. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Do not give oral typhoid vaccine until 72 hours after the last dose of antimicrobial. If possible, to optimize vaccine effectiveness, do not start antibacterial drugs for 72 hours after the last dose of oral typhoid vaccine. A longer interval should be considered for long-acting antimicrobials, such as azithromycin.(3) DISCUSSION: Because antimicrobial therapy may prevent sufficient vaccine-organism replication to generate an immune response, the manufacturer of live-attenuated typhoid vaccine and the Centers for Disease Control (CDC) state that the vaccine should not be administered to patients receiving antimicrobial therapy.(1-3)

VIVOTIF

Drug contraindication overview.

*Known hypersensitivity to ceftriaxone, any other cephalosporin, or any ingredient in the formulation. *History of anaphylaxis to ceftriaxone, cephalosporins, penicillins, or other beta-lactam anti-infectives. *Certain neonates (e.g., premature or hyperbilirubinemic, those requiring calcium-containing IV solutions). *Commercially available premixed (frozen) injection in dextrose may be contraindicated in patients with known allergy to corn or corn products.

Adverse reaction overview.

Common adverse effects include local reactions at the administration site (warmth, tightness, induration, phlebitis), hematologic effects (eosinophilia, thrombocytosis, leukopenia), and hypersensitivity reactions.

Ceftriaxone is contraindicated in premature neonates up to postmenstrual age 41 weeks (i.e., time elapsed since first day of the mother's last menstrual period to birth plus time elapsed after birth). Ceftriaxone is also contraindicated in hyperbilirubinemic neonates, particularly those who are premature. Ceftriaxone can displace bilirubin from albumin binding sites in vitro.

Therefore, there is a possible risk of bilirubin encephalopathy if the drug is used in hyperbilirubinemic neonates. Ceftriaxone is contraindicated in neonates (28 days of age or younger) if they are receiving (or expected to require) treatment with calcium-containing IV solutions, including continuous infusions of calcium-containing solutions such as parenteral nutrition, because of the risk of precipitation of a ceftriaxone-calcium salt. Fatalities associated with ceftriaxone-calcium precipitates in lungs and kidneys have been reported in neonates who received ceftriaxone and calcium-containing IV solutions.

To reduce the risk of bilirubin encephalopathy, IV infusions of ceftriaxone should be given over 60 minutes in neonates. Do not use ceftriaxone IM injections prepared using bacteriostatic water for injection containing benzyl alcohol in neonates Although a causal relationship has not been established, administration of injections preserved with benzyl alcohol has been associated with toxicity in neonates. Toxicity appears to have resulted from administration of large amounts (i.e., about 100-400 mg/kg daily) of benzyl alcohol in these neonates. To avoid unintentional overdosage, the commercially available Duplex(R) drug delivery system containing 1 or 2 g of ceftriaxone and 50 mL of dextrose injection in separate chambers should not be used in pediatric patients who require less than the entire 1- or 2-g dose in the container.

Contraindicated

None

Severe Precaution

None

Management or Monitoring Precaution

None