CEFTRIAXONE ADMINISTRATION
TEMPORARY OR SPECIFIC ORDER
JURISDICTION
Entire health department
DURATION
Indefinite: this order will remain in effect until this order is modified or replaced.
INTRODUCTION
The health department frequently utilizes treatment recommendations from recognized
sources. For example, the Sexually Transmitted Disease Management Guidelines used
by the health department rely heavily on guidelines published from time to time by the
Centers for Disease Control and Prevention. Unfortunately, the supply of medications
made available to the health department does not always perfectly match those
recommendations. For example, ceftriaxone (Rocephin) is sometimes provided only in
250 mg vials whereas certain treatment protocols require only 125 mg. Ceftriaxone is
generally tolerated in doses much greater than 250 mg. Regimens which utilize a dose
of only 125 mg do not actually save money if another 125 mg is wasted. Higher doses
of ceftriaxone provide additional activity against organisms of intermediate sensitivity.
Therefore, it is reasonable to give the full 250 mg dose of ceftriaxone for a regimen
which only requires 125 mg when the alternative is wasting the additional drug.
Unfortunately, some individuals find it uncomfortable to receive an IM injection of
ceftriaxone. Adding injectable lidocaine to the injection can reduce the discomfort.
INDICATIONS AND ORDER
This order applies to all treatment regimens recommended in the standing orders of the
health department including treatment manuals endorsed in by standing orders, such as
the STD Manual (Sexually Transmitted Disease Management Guidelines) and the
Reproductive Health Manual. If the treatment regimen uses 125 mg of ceftriaxone and a
vial of this size is available, then this dose will be used. However, if the only size vial of
ceftriaxone which is available is 250 mg, then it is permissible to give the full 250 mg of
ceftriaxone to the patient. This is not mandatory. It is permitted to give only the required
125 mg dose and to waste the remaining portion of the vial.
If the volume of ceftriaxone being administered intramuscularly is sufficient to anticipate
undue discomfort by the patient, it is permissible to mix 1 cc of 1% lidocaine with the
ceftriaxone before giving the injection. Sterile technique for drawing up the solution and
administering it must be used. Lidocaine which does NOT contain epinephrine should
be selected. If the patient has received a substantial amount of lidocaine from other
procedures during the last several hours then contact the medical director or the
patient’s physician before giving the lidocaine.
CONTRAINDICATIONS
Patients who weigh less than 45 kg are not to receive a higher than regimen dose of
ceftriaxone without first receiving the explicit approval of the medical director.
Ceftriaxone Administration, Page 1 of 2
Patients with a history of hypersensitivity to ceftriaxone, lidocaine, or any of their
components should not receive these medications, respectively.
The permission to administer lidocaine with ceftriaxone in this order only applies to
intramuscular administration.
QUESTIONS
For any circumstance where there is question regarding the appropriateness, safety, or
dosing of ceftriaxone or lidocaine, contact the Medical Director for further instructions.
DISTRIBUTION
STD Manual
Frederick A. Johansen, M.D., F.A.A.P.
Date
Medical Director, Berrien County Health Department
Deputy Medical Director, Van Buren/Cass District Health Department
John R. Spriegel, M.D., M.P.H.
Date
Medical Director, Van Buren/Cass District Health Department
Deputy Medical Director, Berrien County Health Department
Rev: 9/26/2003
StandingOrders/CeftriaxoneAdministration-mhd.doc
Ceftriaxone Administration, Page 2 of 2