Adult outpatient parenteral antimicrobial therapy (OPAT) good practice prescribing guide

Ceftriaxone

Ceftriaxone is a cephalosporin antibacterial that is licensed for many different indications including respiratory tract infections, intra-abdominal infections, complicated urinary tract infections, complicated skin and soft tissue infections, bone and joint infections and central nervous system infections.

This guide shares practical experience of the use of ceftriaxone in an OPAT setting. We took an evidence based approach to create the guidance. We also used expert consensus and practical experience from across NHS Scotland.

This drug summary does not provide specific treatment guidance. Individual patient treatment should take into account the core principles of antimicrobial stewardship. This includes selection of the appropriate antimicrobial for the shortest duration with oral therapy being preferred, whenever possible.

For information on Route and method of administration, Contraindications, Cautions and adverse effects and Drug interactions please refer to the following approved resources:

These resources also have more information on licensed indication, use in pregnancy and use in breast feeding. When using unlicensed medicines, and/or off-label doses or indications, follow local health board governance processes.    

The use of broad spectrum antibiotics is associated with an increased risk of Clostridioides difficile infection (CDI). Please monitor patient for new loose stools. If suspicion of CDI send stool sample to microbiology for analysis.

It is strongly recommended that OPAT services in Scotland adhere to the Key performance indicators for the management of patients in an outpatient parenteral antimicrobial therapy (OPAT) setting.

Ceftriaxone 

1. Indication and dose

Licensed indication(s) in the OPAT setting Dose

Intra-abdominal infections
Complicated urinary tract infections (including pyelonephritis)

 2g 24 hourly

Lower respiratory tract infection
Complicated skin and soft tissue infections
Infections of bones and joints (except Staphylococcus aureus infection)
Lyme Disease (except Central Nervous System)
Bacterial endocarditis (sensitive Streptococcal species)

 2g 24 hourly

Bacterial meningitis
Central Nervous System Lyme disease
Deep seated Staphylococcus aureus infection including bacteraemia bone and joint infections and endocarditis

 4g 24 hourly
OR
2g 12 hourly


Complicated skin and soft tissue infections (cSSTI)

Ceftriaxone is recommended as first line therapy in the SAPG OPAT pathway for the management of adults with complicated skin and soft tissue infections (SSTI). 

This pathway supports reduced hospital admissions and promotes early discharge for patients with complicated skin and soft tissue infections.

2. Dose adjustments

Dosage adjustments may be required under the following circumstances

Patient characteristic Dosage advice
Renal impairment Creatinine Clearance (CrCl) 10ml/min or less Max 2g daily
Haemodialysis (regular three times weekly) Daily dosing.  Do not exceed 2g daily
Hepatic impairment No dose adjustment necessary
Obesity No dose adjustment necessary


3. Monitoring requirements

Frequency

Recommended monitoring
Baseline Urea and Electrolytes (U&Es), liver function tests (LFTs), C-reactive protein (CRP) and full blood count (FBC)
Weekly monitoring
(Note this may be more frequent if clinically necessary)		 U&Es, LFTs, CRP and FBC
Therapeutic drug monitoring No therapeutic drug monitoring required
Follow up Ensure follow up is arranged with referring specialty and/or an infection specialist


For the use of other antibiotics in an OPAT setting please refer to SAPG website

 

  Scottish Antimicrobial Prescribing Group (SAPG) | January 2024 for review January 2027

 

Content updated: April 2024