Training session 9
Cefogram
Category :
  • CEFOGRAM contains Ceftriaxone
  • Ceftriaxone is a broad spectrum, third generation cephalosporin for parenteral use. It has a bactericidal action.
  • Ceftriaxone is stable against beta lactamase producing microorganisms.
  • A long plasma half life ensures once a dosage for 24 hour coverage.
Mechanism of action :
Cefotaxime is a betalactam antibiotic. It inhibits the cell wall synthesis of the bacteria, thus killing the bacteria in the process.
Detailed mechanism of action
Absorption :
Ceftriaxone should not be administered orally. The drug should be administered by intravenous (IV) or intramuscular route (IM).
Distribution :
Ceftriaxone is well distributed in tissues and fluid.
Ceftriaxone penetrates well into:
  • CSF (inflamed and non inflamed meninges)
  • Sputum
  • Tonsil
  • Pleural and peritoneal fluids
  • Ascitic fluid
  • Blister fluid
  • Bile
  • Gall bladder wall
  • Bone
  • Synovial fluid
  • Fallopian tubes
  • Prostate
  • Middle ear mucosa
  • Myometrium & endometrium
Ceftriaxone is bound to plasma proteins. As the concentration of the drug increases in the blood stream, the protein binding decreases
Excretion :
The drug is excreted through urine and bile.

Microbiology :

Gram-negative Aerobes :
Gram-positive Aerobes :
  • Staphylococcus aureus(including pencillinase producing strains)
  • Staphylococcus epidermidis
  • Streptococcus Pyogenes
  • Streptococcus agalactiae
  • Streptococcus pneumoniae
  • Streptococcus viridans
Indication and usage :
  1. Lower respictory track infections
  2. Skin and skin infections
  3. Urinary track infections
  4. Uncomplicated gonorrhoea
  5. Bacterial septicemia
  6. Bone infections
  7. Joint infections
  8. Meningitis
  9. Sugical prophylaxis
Contraindications:
Known allergy to Cephalosporins.

Warnings :
In an individual who is allergic to beta lactam antibiotics, the probability of allergy manifestation to Cefotaxime cannot be ruled out.
Subsequent to the administration of Ceftriaxone, patients who present with diarrhoea should be considered for diagnosis of pseudomembranous colitis.
In vitro studies have shown that Ceftriaxone can displace bilirubin from serum albumin. Ceftriaxone should not be given to neonates who may be at risk of developing bilirubin encephalopathy (especially premature infants)
Precautions :
Use with caution in patients with known allergy to penicillins and other cephalosporins.
Caution should be exercised in patients receiving aminoglycoside antibiotic or potent diuretics such as frusemide.
Superinfection
Pseudomembranous colitis
Pregnancy and Lactation - The usage of Ceftriaxone in Pregnancy has not been established. Ceftriaxone is excreted in breast milk. Hence the drug should not be administered to nursing mothers unless the expected benefits outweigh the potential risks.
Adverse reactions :
Anaphylactic reactions Rash, pruritus, fever/ chills, erythema multiforme
Skin Rash, Pruritus, Urticaria, erythema multiforme, Stevens-Johnson syndrome
Haemotological Eosinophilia, thrombocytosis, leukopenia
Local Pain, tenderness and less frequently Phlebitis. Local reactions were increased if water was used as the diluent instead of lignocaine
Gastrointestinal Nausea, Diarrhoea, rarely pseudomembranous colitis
Hepatic Occasional elevations of SGOT and SGPT
Genitourinary Moniliasis and Vaginitis
Miscellaneous Diaphoresis
Dosage:
Generally the duration of treatment with Ceftriaxone is 4-14 days. In special conditions such as endocarditis, osteomyelitis, infected joints, treatment may be continued for a longer period of time.
Adults:
1 to 2 grams given once a day or in equally divided doses twice a day depending upon the type and severity of infection.
Uncomplicated gonococcal infections - Single IM dose of 250mg is recommended
Surigical Prophylaxis: Cardiovascular surgery, biliary tract surgery, vaginal and abdominal hysterectormy - a single dose of 1gram 2 hours before surgery is recommended.
Children:
50-75mg/kg (not exceed 2 grams) given once per day or individed doses every 12 hours.
In meningitis, the dose should be divided and administered every 12 hours.
Product formulation :
Cefogram(ceftriaxone for injection) - 1gm / 500 mg /250
Benefits :
Cefogram is a third generation cephalosporin antibiotic with a broad spectrum of activity that includes beta lactamase producing microorganism.
The long plasma half life ensures a 24 hour bactericidal activity, there by enabling a once daily dosing schedule.
Competition :
Brand
Company
MONOCEF
ARISTO
OFRAMAX
RANBAXY
POWERCEF
WOCKHARDT
CEFAXONE
LUPIN
 
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