Ceftriaxone Warning
New advice from the MHRA regarding ceftriaxone.
Ceftriaxone is contraindicated in newborns who need calcium treatment because of a risk of precipitation of a ceftriaxone - calcium salt.
In patients of any age, ceftriaxone must not be mixed with calcium-containing solutions, and must not be given to any patient simultaneously with calcium containing solutions - even via different infusion lines.
PICU policy
We will no longer use ceftriaxone in patients being treated for suspected or confirmed sepsis, as this group of patients often receive calcium containing fluids.
Although the MHRA guidance relates to neonates, FDA advice in North America includes a greater age range, and we have decided to stop using ceftriaxone in all age groups to prevent confusion and reduce the chance of error.
At discharge from PICU it is unlikely that calcium containing fluids will be required, so switching to once daily ceftriaxone is permissable. This has the advantage of eradicating nasophrayngeal carriage of pathogenic bacteria in patients with meningitis.
Hartmann's solution is a calcium containing fluid and should not be administered to any patient while they are receiving an infusion of ceftriaxone - even via a different IV line.
To see the full advice from the MHRA click here
